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Reviews: Keith G. Tolman, Vivian Fonseca, Meng H. Tan, and Anthony Dalpiaz Narrative Review: Hepatobiliary Disease in Type 2 Diabetes Mellitus Ann Intern Med 2004; 141: 946-956 [Abstract] [Full text] [PDF]

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Emphysematous Cholecystitis

Ajit S Kashyap, Kuldip P Anand, Surekha Kashyap, and Abhijeet Anand   (2 January 2005)

Emphysematous Cholecystitis 2 January 2005
Ajit S Kashyap, MD,DM Command Hospital (Southern Command),Pune 411 040,India, Kuldip P Anand, Surekha Kashyap, and Abhijeet Anand Send rapid response to journal: Re: Emphysematous Cholecystitis kashyapajits{at}hotmail.com Ajit S Kashyap, et al.	sir, We read with interest the excellent review on hepatobiliary diseases in Type 2 DM (1). However authors do not include emphysematous cholecytitis in hepatobiliary diseases in Type 2 DM. Emphysematous cholecystitis is a highly virulent form of acute cholecystitis characterised by gas production in and around the gall bladder. It is caused by anaerobes clostridium species- welchii and perferingens (46%), aerobic organisms being Escherichia coli (33%), staphylococci, streptococci, and pseudomonas. Emphysematous cholecystitis occurs much more commonly in patients with diabetes, with approximately 35% of all cases involving diabetics(2,3,4). Diabetic vascular disease is thought to play a primary role in the pathogenesis of emphysematous cholecystitis. Narrowing of gallbladder arterioles has been frequently observed on histopathology of surgical specimens, and may lead to arterial insufficiency and ischemia of gallbladder wall. Ischemia creates an anaerobic environment conducive to gas production (2). Morbidity and mortality in this entity is much higher than in other forms of cholecystitis (2,3,4). References 1. Tolman KG, Fonseca V, Tan MH, Dalpiaz D. Narrative review: Hepatobiliary disease in Type 2 Diabetes Mellitus. Ann Intern Med. 2004;141:946-956. 2.Smitherman KO, Peacock Jr. JE. Infectious emergencies in patients with diabetes mellitus.Med Clin North Am. 1995;79: 53-77. 3.Greenberger NJ, Paumgartner G. Diseases of the gallbladder and bile ducts. In :Kasper DL, Fauci AS, Longo DL, Et al. Eds. Harrison's principles of internal medicine. 16th Ed. VolII. McGraw-Hill: New York. 2005:1880-1891. 4.Kasper DL, Madoff LC. Gas gangrene and other clostridial infections.In :Kasper DL, Fauci AS, Longo DL, etal. Eds. Harrison's principles of internal medicine. 16th Ed. VolI. McGraw-Hill: New York. 2005:845-849. Conflict of Interest: