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Acute Acalculous Cholecystitis in Adults: ED Presentation, Evaluation, and Management

As with calculous cholecystitis, ultrasound is the primary imaging modality of choice in the evaluation of AAC. However, the sensitivity and specificity of ultrasound for AAC are not well established, and its primary role in the diagnostic algorithm of AAC remains debated... CT scan has little benefit over US in the evaluation for AAC, however is often employed to investigate alternative intra-abdominal processes and can demonstrate findings suggestive of AAC. CT scan may show findings similar to those in acute calculous cholecystitis, including gallbladder wall thickening (>3mm) or nodularity, poor definition of gallbladder/liver interface, and pericholecystic fluid. However, findings are…

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Articles of Interest

Acute Acalculous Cholecystitis

Since ACC is uncommon, diagnosis is often delayed, with increased mortality. There is no unique marker definitively identifying AAC with high accuracy. The majority of patients with AAC are seriously ill and unable to communicate their symptoms, further complicating diagnosis.

Acalculous cholecystitis

In most cases, this is a clinical diagnosis which is based upon weighing roughly three factors: (a) How persuasive is the evidence of acalculous cholecystitis? (b) How sick is the patient? (c) Are there alternative infectious sources?

Acalculous cholecystitis

The majority of cholecystitis events in the ICU are acalculous... Ideally, to fix this problem surgically is the solution, but practically speaking this is going to be difficult in the critically ill patient. Percutanous cholecystostomy may be the only answer; of those who respond the majority experience and improvement withn 48 hours- but in 41% it seems to make no difference to the severity of their shock, suggesting that in these patients the thick distended gallbladder was mistaken as the source of sepsis. Additionally, putting a tube though somebody’s abdominal wall is non a consequence-free step, and there are reports of horrible complications like bleeding from the liver. The drain may also dislodge during pressure area care, resulting in a spray of infected bile all over the peritoneum.

Acute Acalculous Cholecystitis in Adults: ED Presentation, Evaluation, and Management

Acute acalculous cholecystitis (AAC) is due inflammation of the gallbladder without evidence of gallbladder calculi. AAC is commonly associated with critically ill patients in the ICU, i.e. polytrauma patients, massive burns, cardiac surgery, abdominal vascular surgery, immunosuppression, sepsis, prolonged TPN administration.

Pitfalls of Diagnosis of Acalculous Cholecystitis. Case Presentation and Literature Review.

Acute acalculous cholecystitis (AAC) is an acute inflammation of the gallbladder in absence of gallstones. It is a potentially fatal form of acute cholecystitis that usually occurs in critically ill patients. The disease may often go unrecognized due to the complexity of the patient's medical and surgical problems. Recently, there is a reported increase in the incidence of acalculous cholecystitis in outpatients without typical predisposing critical illness.

What's the Diagnosis?

Acalculous cholecystitis is due to gallbladder (GB) wall ischemia and GB stasis (i.e., from reduced GB contraction secondary to reduced PO intake). The result is gallbladder "sludge" (A), thickened GB walls (B), and pericholecystic fluid (C).

Resources

UMEM Educational Pearls

Take Home Point: Consider AAC in the septic critically ill patient without a source.

Consultant360

Approximately 10% of all cases of gallbladder inflammation are caused by acute acalculous cholecystitis. The incidence of this disorder is rising, and about half of cases are associated with severe trauma or major surgery.

Life in the Fastlane

Often complication of various conditions. high incidence of gangrene -> perforation. high mortality & morbidity. pathophysiology: bile stasis + increased viscosity c/o fever, dehydration, no enteral feeding -> CCK induced gall bladder contraction with wall ischaemia.

Radiopaedia

Acute acalculous cholecystitis refers to the development of cholecystitis in the gallbladder either without gallstones or with gallstones where they are not the contributory factor. It is thought to occur most often due to biliary stasis and/or gallbladder ischemia.

StatPearls

Acalculous cholecystitis is a hypokinetic condition of gallbladder emptying. It often presents as an acute ailment (acute cholecystitis), but it can also exhibit more chronic (chronic cholecystitis) symptoms. Acalculous cholecystitis is a life-threatening disorder that has a high risk of perforation and necrosis compared to the more typical calculous disease.