and an air-fluid level. The CT also showed the air extending into the common bile duct and the biliary tree ( fig. 3 ). Emergency open cholecystectomy was performed. The pathology report confirmed acute necrotizing cholecystitis and Clostridium perfringens was isolated from the bile culture. The patient was treated postoperatively with broad-spectrum antibiotic therapy and recovered uneventfully. A 67-year-old diabetic male presented to the emergency department with severe right hypochondrium

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... in of 3 days' duration, accompanied with fever and vomiting. The temperature was 38.2 ° C, and Murphy's sign was detected. Plain abdominal X-ray film revealed a markedly circular gas pattern ( fig. 1 ) in the right upper quadrant. Subsequent computed tomography (CT) confirmed the presence of air in the gallbladder wall ( fig. 2 )