From the Guidelines
Acalculous Cholecystitis Definition and Treatment
Acalculous cholecystitis is a serious and potentially life-threatening condition that requires prompt medical attention. It is characterized by spontaneous gangrene of the gallbladder without the presence of gallstones, often associated with critical illness, trauma, or biliary surgery 1. The condition can progress to perforation if not diagnosed and treated promptly.
Key Features and Treatment Approach
- Causes and Risk Factors: Acalculous cholecystitis is caused by infection, often by Clostridium perfringens, and may be contributed to by high doses of narcotic agents 1.
- Diagnosis and Treatment: The recommended treatment involves immediate hospitalization and initiation of broad-spectrum antibiotics, such as piperacillin-tazobactam or cefepime, to cover potential bacterial infection.
- Supportive Care: Fluid resuscitation and pain management using medications like morphine are essential.
- Interventional Procedures: In severe cases, percutaneous cholecystostomy may be necessary to decompress the gallbladder, especially in high-risk patients who are deemed unfit for immediate surgery 1.
- Surgical Consultation: Early surgical consultation is crucial, as cholecystectomy may be required once the patient is stabilized.
Monitoring and Follow-Up
Monitoring for potential complications such as gangrene, perforation, and sepsis is crucial, and the patient's condition should be closely followed with regular laboratory tests and imaging studies. Percutaneous cholecystostomy can serve as a bridge to cholecystectomy in acutely ill patients, converting them into more suitable candidates for surgery 1.
From the Research
Definition and Overview
- Acalculous cholecystitis is a rare form of gallbladder inflammation that occurs without the presence of gallstones 2.
- It primarily affects critically ill patients and is associated with high mortality 3, 2, 4.
- The condition can be difficult to diagnose due to the patient's debilitated medical condition and the limitations of biliary imaging techniques 3.
Causes and Risk Factors
- Acalculous cholecystitis can be caused by various factors, including impairment of the gallbladder microcirculation and conditions that lower the gallbladder's resistance to bacterial invasion 5.
- The condition has numerous causes that result in bile stasis and ischemia leading to inflammation and infection in the gallbladder wall 6.
- Viral illnesses can also cause inflammatory responses leading to acalculous cholecystitis, as seen in a case report where acute viral pericarditis presented with clinical and imaging findings consistent with acute acalculous cholecystitis 2.
Diagnosis and Treatment
- Diagnosing acalculous cholecystitis can be challenging, especially in critically ill patients, and requires a high index of suspicion 3, 5, 6.
- Imaging techniques such as ultrasonography, computer tomography, and radionuclide cholescintigraphy can be helpful in diagnosis 6.
- Treatment options include percutaneous cholecystostomy, surgical cholecystectomy, or endoscopically placed metal stent through the gastrointestinal tract into the gallbladder 4.
- Endoscopic ultrasound-guided gallbladder drainage is a novel drainage approach for patients who are poor candidates for surgery 4.