Acute Acalculous Cholecystitis An Increasing Entity

Abstract

Acute acalculous cholecystitis was observed to increase in frequency between 1950 and 1979, an increase that was statistically significant. The greatest part of this increase occurred between 1965 and 1979. Acute acalculous cholecystitis was also found to be associated with a higher mortality rate, more than twice that of acute calculous cholecystitis. Acute acalculous cholecystitis occurred in a variety of clinical settings including bacterial sepsis, severe trauma including surgical trauma and burns, multiple transfusions, and severe debilitation. The lesion in the gallbladder consists of intense injury of blood vessels in the muscularis and serosa similar to those induced experimentally by in vivo activation of factor XII dependent pathways. Possibly because of the intensity of vascular injury, acute acalculous cholecystitis with minimal clinical manifestations may rapidly progress to gangrene with perforation. Undelayed surgical treatment, which has become more widely accepted over the past 50 years, is essential. It may have also contributed to the increased recognition of this clinical entity.

Chronic Acalculous Cholecystitis

“…Such patients in due course may develop acute episodes of their disease, often associated with higher morbidity and mortality rates. 8,9 In our series there was a delay of 9 to 22 weeks before the patient underwent elective cholecystectomy. None of the patients required emergency admission because of exacerbation of the disease.…”

“…13 Oral cholecystography alone rarely provides specific evidence of acalculous disease, but failure of visualization or abnormal emptying patterns after cholecystokinin (CCK) stimulation may heighten suspicion. 7,9,14 Radionucleotide imaging with or without CCK stimulation has also been the subject of conflicting reports in the diagnosis of acalculous disease. 4,9 It would seem, therefore, that despite the increasing sophistication of biliary tract investigation, the diagnosis of chronic acalculous cholecystitis remains predominantly clinical in the presence of typical symptoms and relies on the exclusion of other upper abdomen pathology.…”

“…4,9 It would seem, therefore, that despite the increasing sophistication of biliary tract investigation, the diagnosis of chronic acalculous cholecystitis remains predominantly clinical in the presence of typical symptoms and relies on the exclusion of other upper abdomen pathology. Nevertheless, a satisfactory outcome following cholecystectomy has been reported in 80% to 90% of patients with symptoms similar to those in cholelithiasis, 5,9,10 irrespective of the diagnostic methods used to select patients for surgery, and findings in the present series agree with such results.…”

Acute Acalculous Cholecystitis

“…A multitude of predisposing factors such as acute illness in childhood, specific fevers, extensive burns, polytrauma, and major sur› gical procedures (non-biliary) have been at› tributed as the cause [1,2,[4][5][6]. The patho› genesis which is probably multifactorial in› cludes a possible biliary stasis, increased bile viscocity and lithogenicity, and gall bladder ischaemia [1,7].…”

“…cholecystectomy [1,2,4,7]. In the critically ill, ultrasound guided per cutaneous cholecystostomy has also been described [7].…”