Acute acalculous cholecystitis

an acute life-threatening necroinflammatory disorder of the gallbladder, usually seen in critically ill patients, that is not associated with gallstones

5–10% of acute cholecystitis

conditions predisposing to bile stasis and reduced perfusion of the gallbladder

• Risk factors

  • Multiorgan failure (critically ill patients)

  • Severe trauma, burns

  • Surgery

  • Infection (e.g., CMV)

  • Sepsis, septic shock

  • Total parenteral nutrition

  • Prolonged fasting

  • Immunodeficiency

similar to acute calculous cholecystitis

• Laboratory studies and findings: similar to acute calculous cholecystitis

• Imaging [8][9]

  • Abdominal ultrasound: preferred initial imaging modality [7][9]

    • Supportive findings

      • Signs of gallbladder inflammation: gallbladder wall thickening (> 3–5 mm), pericholecystic fluid

      • No evidence of cholelithiasis (sludge may be present)

  • HIDA scan: preferred confirmatory imaging modality if ultrasound is inconclusive [2][8][9]

    • Supportive findings: similar to acute calculous cholecystitis (see HIDA scan in “Diagnostics” section)

  • CT abdomen with IV contrast: an alternative to HIDA in patients with inconclusive ultrasound findings

    • Supportive findings: similar to those on ultrasound

• Initial supportive management: NPO, IV fluids, analgesics (see ''Treatment'' in ''Acute calculous cholecystitis” for details)

• IV antibiotics: see “Empiric antibiotic therapy for acute biliary infection”

• Source control

  • Low-risk patients: emergency laparoscopic cholecystectomy

  • High-risk patients: percutaneous cholecystostomy

    • If patients do not improve within 2–3 days, cholecystectomy should be performed.