Acute Acalculous Cholecystitis: Diagnosis and Treatment

Last updated: 27 June 2026Medical content lead: Op.Dr.Gökhan ATEŞ

Acute acalculous cholecystitis is acute inflammation of the gallbladder without stones. It typically occurs in patients with severe comorbidities, prolonged ICU stay or major trauma, and requires prompt diagnosis.

Risk factors

  • ICU admission
  • Prolonged fasting and total parenteral nutrition
  • Major trauma or burns
  • Sepsis
  • Severe comorbidities such as diabetes or heart failure

Symptoms

Right-upper-quadrant tenderness, fever and leukocytosis; in sedated patients the picture may be subtle, so clinical suspicion is essential.

Diagnosis

Ultrasound is the first step — wall thickening, pericholecystic fluid and a sonographic Murphy sign are typical. CT and HIDA scintigraphy may support diagnosis.

Treatment

  • Antibiotics and supportive care
  • Early laparoscopic cholecystectomy when feasible
  • Percutaneous cholecystostomy in severely ill patients unfit for surgery

Frequently Asked Questions

It represents roughly 5–10% of all cholecystitis cases but tends to be more severe.

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