Advances in the Study of Acute Acalculous Cholecystitis: A Comprehensive Review

Abstract

<b><i>Background:</i></b> Acute acalculous cholecystitis (AAC) is characterized by acute necrotizing inflammation with no calculi and is diagnosed based on imaging, intraoperative, and pathological examinations. <b><i>Key Message:</i></b> Although AAC has been studied clinically for a long time, it remains difficult to diagnose and treat. The pathogenesis of AAC is still not fully understood, and it is often regarded as a relatively independent clinical disease that is different from acute calculous cholecystitis (ACC). Pathological studies suggest that AAC is the manifestation of a critical systemic disease, while ACC is a local disease of the gallbladder. <b><i>Summary:</i></b> Concerning the pathogenesis, diagnosis, and treatment of AAC, we reviewed the research progress of AAC, which will enhance the understanding of the early diagnosis and treatment of AAC.

HAV-induced Acalculous cholecystitis: A case report and literature review

“…[12][13][14][15] As a rare extrahepatic manifestation of HAV, AAC is an acute inflammatory disease of the gallbladder without evidence of cholecystolithiasis which comprises 5-10% of all acute cholecystitis cases. 16 AAC usually manifests in critically-ill patients, especially those hospitalized in the intensive care unit (ICU), and is associated with several risk factors (e.g., fasting, total parenteral nutrition, mechanical ventilation, shock, and sepsis) and high mortality (around 30-50%). [17][18][19] The pathogenesis of AAC is multifactorial, anatomical and functional, such as gallbladder ischemia, bile excretion disorder, cholestasis, and microbial infection.…”

Acalculous cholecystitis is a common extrahepatic manifestation of hepatitis E and suggests a more serious condition

“…Hepatitis E (HE) is a disease mainly transmitted by the digestive tract caused by the hepatitis E virus (HEV), and its extrahepatic manifestations are currently reported mainly include acute pancreatitis (1), neurological diseases (2,3), kidney injury (4), hematological disorders (5,6). Acalculous cholecystitis refers to in ammation of gallbladder without gallstone, which is usually caused by mechanical factors, chemical materials, and infection (7). Metabolites of virus may invade the wall of the gallbladder or biliary epithelial cells, leading to cholestasis, which in turn results in acalculous cholecystitis (7,8).…”

“…Acalculous cholecystitis refers to in ammation of gallbladder without gallstone, which is usually caused by mechanical factors, chemical materials, and infection (7). Metabolites of virus may invade the wall of the gallbladder or biliary epithelial cells, leading to cholestasis, which in turn results in acalculous cholecystitis (7,8). Although it was reported in 1987 that acalculous cholecystitis may be an extrahepatic complication of liver disease (9), viral hepatitis related acalculous cholecystitis is mostly reported in hepatitis A (10)(11)(12)(13)(14)(15)(16)(17), and a few are hepatitis B (18) and C (19)(20)(21).…”

The incidence of acute acalculous cholecystitis in critically ill COVID-19 patients

“…Here we present three patients diagnosed with severe COVID-19 who developed acute acalculous cholecystitis (AAC) after a prolonged ICU stay.AAC is a rare form of cholecystitis not associated with the presence of gallstones. In this case, inflammation of the gallbladder is due to hypomotility, which induces accumulation of bile with a secondary increase in intraluminal pressure that leads to inflammation, ischemia, and necrosis of the gallbladder wall [1,2]. The accumulation of bile can also promote bacterial colonization and sepsis.…”

“…In critically ill patients, the incidence of AAC is low (<1%), although it can be as high as 5% in at-risk populations, such as those suffering from burns or trauma, and in patients undergoing major surgery [ 1 , 2 ]. The three cases described in this report represent approximately 3% of the COVID-19 patients who received IMV in our center (n=96) during this period, a proportion that is in line with the aforementioned incidence rate in at-risk populations.…”