From the Research
Definition and Causes
- Acute acalculous cholecystitis (AAC) is an inflammation of the gallbladder without the presence of gallstones 1, 2, 3, 4, 5.
- AAC can occur in critically ill patients, but it has also been implicated as a cause of cholecystitis in previously healthy individuals 1.
- The pathogenesis of AAC is complex and involves multiple mechanisms, including bile stasis, gallbladder ischemia, direct invasion of the gallbladder epithelial cells, gallbladder vasculitis, obstruction of the biliary tree, and sequestration 1, 2.
Comparison with Calculous Cholecystitis
- Calculous cholecystitis is an inflammation of the gallbladder associated with the presence of gallstones.
- AAC is less common than calculous cholecystitis, but it can be fatal if not treated 3.
- The treatment of AAC is different from calculous cholecystitis, with percutaneous cholecystostomy being the mainstay of therapy for AAC 2.
Diagnosis and Treatment
- Ultrasound of the gallbladder is the most accurate diagnostic modality for AAC, with gallbladder wall thickness of 3.5 mm or greater and pericholecystic fluid being the two most reliable criteria 2.
- The historical treatment of choice for AAC has been cholecystectomy, but percutaneous cholecystostomy is now the preferred treatment, controlling the disease in about 85% of patients 2.
- Interval cholecystectomy is usually not indicated after AAC in survivors, if the absence of gallstones is confirmed and the precipitating disorder has been controlled 2.