Acalculous cholecystitis
Background
- Acute necroinflammatory disease of gallbladder with multifactorial pathogenesis
- Gallbladder stasis and ischemia leads to distension and eventually necrosis/perforation
- Accounts for 10% of acute cholecystitis; associated with high morbidity/mortality
Risk Factors
- Burns
- CAD
- DM
- Immunosuppression
- Infection
- Mechanical ventilation
- Medications (eg, opiates, sunitinib)
- Multiple transfusions
- Nonbiliary surgery
- Sepsis/hypotension
- Vasculitis
Clinical Features
- Similar to calculous cholecystitis
- Jaundice is common (20% of pts)
DDX
- Calculous cholecystitis
- Peptic ulceration w/ or w/o perforation
- Acute pancreatitis
- Right-sided pyelonephritis
- Hepatic or subphrenic abscess
Work-Up
- CBC
- Chemistry
- LFTs
- Blood cx
- Ultrasound
Diagnosis
- Leukocytosis (70-85% of pts)
- LFT abnormalities
- Hyperbilirubinemia
- Alk phos elevation (mild)
- Transaminitis
- Ultrasound findings:
- Absence of gallstones or sludge
- Thickened wall (>5 mm) with pericholecystic fluid
- Positive sonographic Murphy's sign
- Emphysematous cholecystitis w/ gas bubbles arising in fundus of gallbladder
- Frank perforation of gallbladder with associated abscess formation
Treatment
- Abx
- Ceftriaxone + metronidazole OR
- Piperacillin/tazobactam
- Cholecystectomy
- Definitive therapy
Disposition
- Admit
Source
- UpToDate