Related Subjects:Acute Cholecystitis
|Acute Appendicitis
|Chronic Peritonitis
|Abdominal Aortic Aneurysm
|Ectopic Pregnancy
|Acute Cholangitis
|Acute Abdominal Pain/Peritonitis
|Assessing Abdominal Pain
|Penetrating Abdominal Trauma
|Acute Pancreatitis
|Acute Diverticulitis
⚠️ Acalculous cholecystitis is an inflammatory condition of the gallbladder caused by impaired emptying without gallstones.
It usually occurs in critically ill ICU patients (e.g. trauma, sepsis, burns, multiorgan failure).
CT scan is the preferred initial imaging test.
📖 About
- Occurs in critically ill, older patients (often male).
- Similar presentation to acute calculous cholecystitis, but no gallstones present.
- Associated with a worse prognosis than gallstone-related cholecystitis.
🧬 Aetiology
- Inflammatory disease of the gallbladder without cystic duct obstruction.
- Due to bile stasis, ischemia, and secondary infection.
🔗 Risk Factors & Associations
- Diabetes mellitus
- Sepsis / multiorgan failure
- Prolonged fasting or TPN
- Post cardiac, vascular, or abdominal surgery
- Severe trauma or burns
- Opiate use (slows gallbladder motility)
- Ischaemic heart disease
- HIV infection
🩺 Clinical Features
- Patients often critically ill with multiple comorbidities.
- Symptoms: RUQ pain, fever, systemic sepsis features.
- Signs: Positive Murphy’s sign (less reliable in ventilated patients).
🔍 Investigations
- Bloods: ↑ WCC, ↑ CRP, deranged LFTs, possible AKI.
- USS: Gallbladder wall thickening (>3–5 mm), pericholecystic fluid, no gallstones. May show emphysematous change or perforation.
- CT scan: Preferred. Wall thickening (>4 mm), pericholecystic fluid, intramural gas, mucosal sloughing.
- HIDA scan: Failure of gallbladder opacification. Sensitivity ~100%.
⚠️ Complications
- Sepsis and septic shock
- Gallbladder gangrene
- Perforation → peritonitis
- Pericholecystic abscess
- ARDS (due to systemic inflammatory response)
🔎 Differential Diagnosis
- Calculous cholecystitis
- Peptic ulcer disease
- Acute pancreatitis
- Right-sided pyelonephritis
- Liver / subphrenic abscess
💊 Management
- Supportive: ABC resuscitation, IV fluids, analgesia, HDU monitoring.
- Antibiotics: Broad-spectrum cover against Gram-negatives & anaerobes.
- Definitive:
- Urgent cholecystectomy (laparoscopic or open) if patient stable.
- Percutaneous cholecystostomy (radiological drain) for unstable/high-risk patients.
- ERCP with stenting may be considered in selected cases.
- Prognosis: Often poor in frail or ICU patients; recovery may be prolonged and incomplete.
📚 References
