Acute acalculous cholecystitis
Acute acalculous cholecystitis refers to the development of cholecystitis either in a gallbladder without gallstones or in a gallbladder with gallstones where the stones are not the contributory factor.
Acute acalculous cholecystitis represents 5-10% of acute cholecystitis cases.
Acute acalculous cholecystitis usually occurs in critically ill or injured patients (e.g. trauma, burns, sepsis). Ischaemia/reperfusion injury to the gallbladder is a central pathogenic feature. Other causes may include 9:
- bile stasis, e.g. from various causes of cystic duct obstruction
- opioid therapy
- positive-pressure ventilation (PPV)
- total parenteral nutrition (TPN)
- cocaine-related (rare)
When there are no gallstones, the diagnosis is easier.
May show gallbladder wall oedema with pericholecystic fluid with gallbladder distention (the former two considered two most important criteria 2). The sonographic Murphy's sign may be positive. A sonolucent intramural layer or “halo” that represents intramural oedema may also be present.
Tc-99m iminodiacetic acid cholescintigraphy is considered a highly reliable test and may be performed even in acutely ill patients. There is usually non-visualisation of the gallbladder.
Treatment and prognosis
The importance of recognizing acalculous cholecystitis lies in the fact that these patients have a high rate of recurrence when treated with medical management. As such, cholecystectomy is the definitive treatment. However, patients that are not fit for surgery can undergo percutaneous or endoscopic biliary drainage as alternative therapy, though cholecystectomy may still be performed when the patient improves.
- 1. Joseph T, Unver K, Hwang GL et-al. Percutaneous cholecystostomy for acute cholecystitis: ten-year experience. J Vasc Interv Radiol. 2012;23 (1): 83-8.e1. doi:10.1016/j.jvir.2011.09.030 - Pubmed citation
- 2. Barie PS, Eachempati SR. Acute acalculous cholecystitis. Gastroenterol. Clin. North Am. 2010;39 (2): 343-57, x. doi:10.1016/j.gtc.2010.02.012 - Pubmed citation
- 3. Mirvis SE, Vainright JR, Nelson AW et-al. The diagnosis of acute acalculous cholecystitis: a comparison of sonography, scintigraphy, and CT. AJR Am J Roentgenol. 1986;147 (6): 1171-5. AJR Am J Roentgenol (citation) - Pubmed citation
- 4. Ananian C, Dunn A, Mansourian V et-al. Scintigraphic gallbladder visualization with gangrenous acalculous cholecystitis. Clin Nucl Med. 2006;31 (11): 701-3. doi:10.1097/01.rlu.0000242700.10483.08 - Pubmed citation
- 5. Swayne LC. Acute acalculous cholecystitis: sensitivity in detection using technetium-99m iminodiacetic acid cholescintigraphy. Radiology. 1986;160 (1): 33-8. Radiology (citation) - Pubmed citation
- 6. Ramanna L, Brachman MB, Tanasescu DE et-al. Cholescintigraphy in acute acalculous cholecystitis. Am. J. Gastroenterol. 1984;79 (8): 650-3. - Pubmed citation
- 7. Weissmann HS, Berkowitz D, Fox MS et-al. The role of technetium-99m iminodiacetic acid (IDA) cholescintigraphy in acute acalculous cholecystitis. Radiology. 1983;146 (1): 177-80. Radiology (citation) - Pubmed citation
- 8. Tulchinsky M, Colletti PM, Allen TW. Hepatobiliary scintigraphy in acute cholecystitis. Semin Nucl Med. 2012;42 (2): 84-100. doi:10.1053/j.semnuclmed.2011.10.005 - Pubmed citation
- 9. Henryk Dancygier. Clinical Hepatology. ISBN: 9783540938422