Acute Acalculous Cholecystitis: Diagnosis and Treatment
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
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