Biliary peritonitis revealing acalculous gangrenous cholecystitis

Gangrenous acalculous cholecystitis (GAC) is an acute nonspecific inflammation of the gall bladder, occurring in the absence of any gallstone in the bile ducts and whose symptoms start abruptly, rapidly evolving requiring urgent therapeutic decisions. GAC was described for the first time in 1947 by Glenn. We report the case of a 74-year-old patient who had poorly followed diabetes and presents an abdominal pain with a clinical examination that found a generalized abdominal defense. Abdominal ultrasonography showed a finely echogenic peritoneal effusion of moderate abundance, a tumbled appendix at 8.3 mm, and a semi-replicated gallbladder that appears free of gallstones.
Emergency laparotomy showed gangrenous patches on the gallbladder wall, cholecystectomy was done and histopathology revealed gangrenous cholecystitis. So, in case of acute cholecystitis and in the presence of risk factors, gangrenous cholecystitis should be one of the differential diagnoses in order to avoid serious complications.