From the Guidelines
Acalculous cholecystitis is a serious condition that requires prompt medical attention, accounting for up to 40% of cases of acute cholecystitis, particularly in immunocompromised patients 1.
Key Characteristics
- It is characterized by inflammation of the gallbladder without the presence of gallstones 1.
- The condition can lead to gangrene of the gallbladder and has a high mortality rate if left untreated 1.
- Acalculous cholecystitis often occurs in critically ill patients, such as those who have undergone transplantation or have other severe medical conditions 1.
Diagnosis and Treatment
- Diagnosis is typically made using a combination of clinical signs, laboratory tests, and imaging studies, such as ultrasound or CT scans 1.
- Treatment usually involves antibiotics and supportive care, with percutaneous cholecystostomy or surgical intervention considered in severe cases 1.
- Laparoscopic cholecystectomy is a feasible and preferred treatment option for transplanted patients with acute cholecystitis, whenever possible 1.
- Percutaneous cholecystostomy may be a useful temporary or permanent procedure in patients with acute cholecystitis of both calculous and acalculous origin, who are unfit for surgery 1.
Important Considerations
- Prompt recognition and treatment are essential to prevent complications and improve outcomes in patients with acalculous cholecystitis 1.
- A multidisciplinary approach to diagnosis and treatment is recommended, involving collaboration between healthcare professionals from various specialties 1.
From the Research
Definition and Characteristics
- Acalculous cholecystitis is defined as acute inflammation of the gallbladder in the absence of gallstones 2.
- Patients with acalculous cholecystitis are usually critically ill with underlying conditions such as atherosclerotic heart disease, recent trauma, burn injury, surgery, or hemodynamic instability 2.
- The presentation of acalculous cholecystitis may be insidious, with symptoms such as unexplained fever, leukocytosis, hyperamylasemia, or abnormal aminotransferases, and patients often lack right upper quadrant tenderness 2.
Diagnosis and Treatment
- Diagnostic evaluation includes ultrasonography, computerized tomography, and cholescintigraphy 2.
- Treatment options include cholecystectomy, percutaneous transhepatic cholecystostomy, and endoscopic therapy with nasobiliary drainage and lavage 2, 3, 4.
- Endoscopic ultrasound-guided gallbladder drainage is a novel drainage approach for patients who are poor candidates for surgery 4.
- The choice of treatment modality depends on the patient's condition and the severity of the disease 4.
Epidemiology and Outcomes
- Acalculous cholecystitis is a rare but serious condition with high morbidity and mortality 3, 5.
- The incidence of acalculous cholecystitis seems to be increasing 3.
- Postoperative mortality and morbidity rates are high, ranging from 30% to 55% 3.
- Prompt diagnosis and treatment are essential to improve outcomes in patients with acalculous cholecystitis 3, 5.