Emphysematous cholecystitis is a rare variation of acute cholecystitis caused by secondary infection of the gallbladder wall with gas-forming bacteria such as Clostridium welchii, Clostridium perfringens, Escherichia coli, and Bacteroides fragilis as well as Pseudomonas, staphylococci, and streptococci. Men between the ages of 50 and 70 are most frequently affected. Type 2 diabetes and gallstones are common in affected patients. Emphysematous cholecystitis can also arise due to ischemia from atherosclerosis of the cystic artery.

Common presenting symptoms are similar to those for acute cholecystitis and include upper right quadrant abdominal pain, nausea, vomiting, and low-grade fever. On physical exam, abdominal wall crepitus may be palpated in the area overlying the gallbladder. Common complications include gangrene, perforation, pericholecystic abscess, and peritonitis. Uncommon complications include pneumoperitoneum.

Emergent antibiotic therapy followed by cholecystectomy is the treatment of choice due to increased risk of perforation.