The emphysematous cholecystitis is a relatively rare variant of acute cholecystitis, seen most frequently in elderly, debilitated, or diabetic patients.

It’s characterized by the presence of gas in the gallbladder lumen, wall or pericholecystic tissues in the absence of an abnormal communication between the biliary system and the gastrointestinal tract.

We must always keep this diagnostic in mind because this entity is potentially more severe than acute non-emphysematous cholecystitis, with a approximated thirty times higher risk of gangrene and perforation five times higher.

The radiological assessment is the standard method for the evaluation of bile ducts and gallbladder disease. It’s the only way to make an early diagnostic, which one remains a challenge in the practice due to a high degree of misdiagnosis by the habitual methods.

The purpose of this article is make a review of the clinical features, the methods of diagnosis and the treatment of this pathology.