What is acalculous cholecystitis?
Acute Acalculous Cholecystitis
Acute acalculous cholecystitis is a life-threatening condition, which usually occurs in older severely ill patients in intensive care units. It can develop due to decreased motility and blood perfusion of the gallbladder within 1-50 days of the triggering event, such as [1,5]:
- Critical illness (burns, sepsis, trauma, congestive heart failure, hypovolemic shock)
- Recent surgery
- Prolonged fasting or intravenous feeding (total parenteral nutrition)
- Bacterial: brucellosis, cholera, leptospirosis, salmonellosis, tuberculosis, typhoid fever
- Viral: cytomegalovirus infection, Dengue fever, hepatitis A, advanced HIV/AIDS, infectious mononucleosis (Ebstein-Barr virus)
- Fungal: candidiasis
- Parasitic: cyclosporiasis, malaria, microsporidiosis, schistosomiasis
A milder form of acute acalculous cholecystitis can be, rarely, associated with a chronic condition, such as [1,2]:
- Poorly controlled diabetes mellitus
- Cancer with metastases
- Systemic lupus erythematosus
Chronic Acalculous Cholecystitis
Chronic acalculous cholecystitis appears to be much less severe than the acute one. It can develop without an apparent cause or can be associated with impaired gallbladder motility or accumulation of cholesterol in the gallbladder wall (cholesterolosis) [4,6].
Symptoms of acalculous cholecystitis can include pain and tenderness in the right upper abdominal quadrant and nausea within an hour of a fatty meal .
Common complications of acute acalculous cholecystitis include gallbladder infection, perforation and gangrene, which all increase the risk of death.
In acalculous cholecystitis, ultrasonography typically reveals one or more of the following: distended gallbladder, thickened gallbladder wall, gallbladder sludge and absence of gallstones [1,7].
Picture 1. An ultrasound image of acute acalculous cholecystitis
showing a thick gallbladder wall and no gallstones
(source: Hindawi, CC license)
Scintigraphy (HIDA scan) usually reveals low gallbladder function (low ejection fraction).
It is a pathologist who can make a final diagnosis of acalculous cholecystitis after examination of the removed gallbladder.
Conditions that can have similar symptoms as acalculous cholecystitis [3,5]:
- Gallbladder attack caused by gallstones
- Acute calculous cholecystitis
- Irritable bowel syndrome
- Sphincter of Oddi dysfunction
- Peptic ulcer
When possible, acute and chronic acalculous cholecystitis are treated by a surgical removal of the gallbladder. When surgery is not possible, the treatment can include:
- An insertion of a stent (tube) between the gallbladder and small intestine
- Gallbladder drainage through the abdominal wall (percutaneous cholecystostomy)
Among severely ill patients with acute acalculous cholecystitis, the reported mortality is about 40% . In individuals without a severe underlying disease, the prognosis after gallbladder removal is excellent .
About 80% of individuals with chronic acalculous cholecystitis report permanent pain relief after gallbladder removal [3,4].
- Huffman JL et al, 2010, Acute acalculous cholecystitis – a review Clinical Gastroenterology and Hepatology
- Ganpathi IS et al, 2007, Acute acalculous cholecystitis: challenging the myths PubMed Central
- Jones-Monahan K et al, 1999, Chronic Acalculous Cholecystitis: Changes in Patient Demographics and Evaluation Since the Advent of Laparoscopy PubMed Central
- Chen PF et al, 2001, The clinical diagnosis of chronic acalculous cholecystitis PubMed
- Thosani AJ, Acalculous cholecystopathy Emedicine
- Surlin V et al, 2013, Histologic Aspects and Outcome of Laparoscopic Cholecystectomy in Chronic Acalculous Cholecystitis Current Health Sciences Journal
- Debnath J et al, 2010, Is it acalculous cholecystitis or reactive/viral pericholecystits in acute hepatitis? SciELO