Author(s)

Alexandra N. Dominianni¹, Samantha A. Delapena², Luis G. Fernandez^3,4,5,6,7,8, Mostaffa T. Jabassini⁹, Sean F. O’Keefe¹⁰, Rachel L. Villanueva¹¹, Marc R. Matthews^12*

¹College of Medicine-Phoenix, University of Arizona, Phoenix, AZ, USA.
²Creighton University Arizona Health Education Alliance, Phoenix, AZ, USA.
³Department of Surgery, Division of Trauma Surgery/Surgical Critical Care, The University of Texas Health Science Center, Tyler, TX, USA.
⁴The University of Texas-Tyler School of Medicine Bill Barrett Endowed Chair in Trauma Surgery, Tyler, TX, USA.
⁵Trauma Wound Care, UT Health East, Tyler, TX, USA.
⁶Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA.
⁷Adjunct Clinical Professor of Medicine and Nursing, University of Texas, Arlington, TX, USA.
⁸Past Commanding General TXSG Medical Brigade, Austin, TX, USA.
⁹Surgical Resident, Abrazo Health Network General Surgery Residency, Glendale, AZ, USA.
¹⁰Area Sales Manager, Miach Orthopedics.
¹¹Surgical Acute Account Manager, 3M, Minneapolis, MN, USA.
¹²Clinical Professor of Surgery, Banner University of Arizona/University Medical Center, Tucson, AZ, USA.

Emphysematous cholecystitis is a rare subtype of acute cholecystitis characterized by the presence of gas in the gallbladder wall secondary to ischemia. Typically, this is a result of cystic artery vascular compromise with a concomitant infection from gas-forming organisms such as Clostridium species, Klebsiella species, or Escherichia coli. The mortality rate of acute emphysematous cholecystitis is 15% - 20% compared with 1.4% in uncomplicated acute cholecystitis. The subsequent development of a cholecystocutaneous fistula, an abnormal connection between the gallbladder and the skin, is also a rare complication of gallbladder disease. We describe a case of a 77-year-old male who presented with right flank necrotizing fasciitis which developed from a cholecystocutaneous fistula secondary to emphysematous cholecystitis. Once the necrotic tissues were adequately debrided, the large open wound was treated with negative pressure wound therapy with instillation (NPWT-i) utilizing hypochlorous acid (HOCL). The wound was closed with a split-thickness skin graft.

Emphysematous Cholecystitis, Gangrenous Cholecystitis, Cholecystocutaneous Fistula, Necrotizing Fasciitis, Sepsis

Dominianni, A. , Delapena, S. , Fernandez, L. , Jabassini, M. , O’Keefe, S. , Villanueva, R. and Matthews, M. (2023) Necrotizing Fasciitis Secondary to Emphysematous Cholecystitis and Cholecystocutaneous Fistula: A Rare Case Report Presentation. Surgical Science, 14, 388-397. doi: 10.4236/ss.2023.145043.