Acute acalculous cholecystitis

Discuss acute acalculous cholecystitis?
It generally occurs in critically ill patients but can occur in ambulatory patients too. It can rapidly progress to gangrene and perforation, since the pathophysiologic process appears to be transmural infarction of the gallbladder wall rather than inflammatory changes associated with stones.
Discuss the clinical features of acalculous cholecystitis?

Abdominal pain, fever, and RUQ tenderness or signs of local peritoneal irritation. Almost all have abnormal liver function tests and leukocytosis.

Discuss the diagnosis?
USS and CT scan
Discuss the treatment?
Treatments for acute acalculous cholecystitis include percutaneous cholecystostomy, open
cholecystostomy, and cholecystectomy (depending on the general condition of the patient).
Even though acute acalculous cholecystitis may result from infarction of the gallbladder wall,
decompression of the gallbladder by placement of a cholecystostomy tube may be sufficient
to control the inflammatory process.
If cholecystectomy is necessary, the degree of inflammation and induration usually precludes the laparoscopic approach.
The mortality rate is 50% if surgery is not performed. The mortality rate associated with surgical intervention in these patients ranges from 6% to 9%, which is significantly higher than with calculous disease. The mortality is related primarily to the patient’s overall condition.


  1. David P. Vogt. Gallbladder disease: An update on diagnosis and treatment. Cleveland clinic of journal of medicine. Vol 69 No 12

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