Chronic Acalculous Cholecystitis

Abstract

Chronic acalculous cholecystitis is a controversial disorder, and surgeons are reluctant to perform cholecystectomy in the absence of clear evidence of biliary calculi. This report describes the clinical picture, investigations, and results of cholecystectomy in 20 patients diagnosed as having chronic acalculous cholecystitis. All the patients had right upper quadrant pain, highly suggestive of gallbladder origin. In six patients ultrasonography and cholecystography were completely normal, two patients showed evidence of "biliary sludge" in the gallbladder, and in the remaining 12 patients, the sole abnormality was ultrasonographic demonstration of a thickened gallbladder wall. At assessment 1 year after cholecystectomy, 17 patients were completely relieved of symptoms, two were improved, and only one patient failed to benefit. Despite the increasing sophistication of biliary tract investigative methods, the diagnosis of chronic acalculous cholecystitis remains predominantly clinical. In the presence of typical symptoms, and with exclusion of other upper abdominal pathology, cholecystectomy successfully relieves the majority of symptoms.