Acalculous cholecystitis is an inflammatory health condition of the gallbladder in which there is no evidence of gallstones on the routine testing.
It commonly occurs in critically ill patients and who are on artificial ventilation or suffering from sepsis. Other risk factors include diabetes, human immunodeficiency virus infection, total parenteral nutrition, prolonged fasting, or being an ICU patient. It is usually a complication of other health conditions.
It has a higher risk of perforation and gangrene when compared to calculus cholecystitis. The overall incidence of acalculous cholecystitis is 5% in all cases of cholecystitis.
The acalculous cholecystitis can present with similar symptoms and signs as that of calculus cholecystitis. Common symptoms manifesting in this condition are:
- Nausea and/or vomiting
- Pain in the right upper quadrant of the abdomen that usually appears after meals.
- Food intolerance
- Abnormal bowel movements and abdominal distension.
The differential diagnoses that need to be considered while diagnosing acalculous cholecystitis are:
- Calculus cholecystitis
- Ascending cholangitis
- Acute pancreatitis
- Gastric issues like a stomach ulcers
- Liver conditions like hepatic abscesses and hepatitis
- Kidney diseases like pyelonephritis.
How to diagnose?
In acalculous cholecystitis, biochemical lab tests don’t provide comprehensive and conclusive clues towards establishing a diagnosis. Generally, radiological tests like ultrasound and CT scan are used to diagnose acalculous cholecystitis, and sometimes nuclear imaging tests like HIDA (hepatobiliary iminodiacetic acid, also called cholescintigraphy) scan can also be used.
It is the most common and best diagnostic test for acalculous cholecystitis. On ultrasound, an enlarged and edematous gallbladder is seen. There is also thickening of the wall of the gallbladder, presence of fluid in the bile duct, and mucosal sloughing.
Computer tomography is usually indicated when there is a need to narrow down diagnosis from a broad list of differential diagnoses or no clear findings on ultrasound. Usually, similar findings are observed on a CT scan. Overall, the sensitivity and specificity of the CT scan are similar to the ultrasound.
This test has no significant advantage over other diagnostic modalities. The specificity and sensitivity of this test are generally lower than ultrasonography and CT scan.
Common surgical and nonsurgical treatment options for acalculous cholecystitis are as follow:
- Percutaneous Cholecystostomy: It is the treatment of choice. It is a minimally invasive procedure. During this procedure, a catheter is placed in the gallbladder lumen and it is used for drainage. This treatment option is usually used in patients who are unstable and unfit for general anesthesia that is required for cholecystectomy. It can also be used as an adjunct therapy with cholecystectomy.
- Cholecystectomy: This is a surgical treatment option. In this surgery, the whole gallbladder is removed by doing open or laparoscopic surgery. It is the definitive treatment and its need is increased if there is an indication of gangrene or perforation of the gallbladder.
- Antibiotics: Antibiotics are indicated in patients who have a superimposed infection. Commonly, broad-spectrum antibiotics are used.
Internet book of critical care, Acalculous cholecystitis, Accessed April 30, 2021, https://emcrit.org/ibcc/acalculous-cholecystitis/
Sciencedirect, Acalculous cholecystitis, Accessed April 30, 2021, https://www.sciencedirect.com/topics/medicine-and-dentistry/acalculous-cholecystitis
Uptodate, Acalculous cholecystitis: Clinical manifestations, diagnosis, and management, Accessed April 30, 2021, https://www.uptodate.com/contents/acalculous-cholecystitis-clinical-manifestations-diagnosis-and-management