From the Research
Right ventricular infarction can lead to acalculous cholecystitis due to hemodynamic changes and reduced perfusion, and management should prioritize treating the underlying cardiac condition and acalculous cholecystitis with a multidisciplinary approach. The connection between these conditions stems from the reduced cardiac output from right ventricular infarction causing splanchnic hypoperfusion, which leads to gallbladder ischemia and subsequent inflammation without gallstones, resulting in acalculous cholecystitis 1.
Key Considerations
- Management includes treating the underlying cardiac condition with antiplatelet therapy (aspirin 81-325mg daily), anticoagulation (heparin followed by warfarin with INR 2-3), and cardiac support measures 1.
- For the acalculous cholecystitis, initial treatment involves NPO status, IV fluids, broad-spectrum antibiotics (piperacillin-tazobactam 3.375g IV q6h or ceftriaxone 1g IV daily plus metronidazole 500mg IV q8h for 7-10 days), and pain management 2.
- Percutaneous cholecystostomy may be needed if the patient is too unstable for surgery, with cholecystectomy considered after cardiac stabilization 2, 3.
- Close monitoring of cardiac function, fluid status, and electrolytes is essential as right ventricular dysfunction can worsen with excessive fluid administration 1.
Diagnostic Approach
- Ultrasonography of the right upper quadrant has a sensitivity of approximately 81% and a specificity of approximately 83% for the diagnosis of acute cholecystitis 2.
- Hepatobiliary scintigraphy is the gold standard diagnostic test when an ultrasound result does not provide a definitive diagnosis 2.
Treatment Outcomes
- Early laparoscopic cholecystectomy is associated with improved patient outcomes, including fewer composite postoperative complications, a shorter length of hospital stay, and lower hospital costs 2.
- Percutaneous cholecystostomy tube placement is an effective therapy for patients with an exceptionally high perioperative risk, but is associated with higher rates of postprocedural complications compared to laparoscopic cholecystectomy 2.