Approach Considerations

It is crucial that clinicans rapidly identify cases of acute acalculous cholecystitis to avoid a delay in treatment and consequent clinical deterioration of affected patients.^[2]

A complete blood cell (CBC) count, liver function studies, and blood culture tests are some of the main laboratory tests that should be performed. However, note that laboratory findings may be negative or inconclusive in late-stage disease,^[2]and bile culture results are negative in nearly 50% of patients with acalculous cholecystitis, probably because of concurrent antibiotic therapy in these patients.

Perform abdominal ultrasonography^[2]or computed tomography (CT) scanning.

For surgical candidates, perform cholecystectomy using an open or laparoscopic approach as indicated. For patients who are not surgical candidates, perform percutaneous cholecystostomy.^{[10, 11, 12, 13]}

Treatment & Management

Treinen C, Lomelin D, Krause C, Goede M, Oleynikov D. Acute acalculous cholecystitis in the critically ill: risk factors and surgical strategies. Langenbecks Arch Surg. 2015 May. 400(4):421-7. [QxMD MEDLINE Link].
Tana M, Tana C, Cocco G, Iannetti G, Romano M, Schiavone C. Acute acalculous cholecystitis and cardiovascular disease: a land of confusion. J Ultrasound. 2015 Dec. 18(4):317-20. [QxMD MEDLINE Link].
Theodorou P, Maurer CA, Spanholtz TA, et al. Acalculous cholecystitis in severely burned patients: incidence and predisposing factors. Burns. 2009 May. 35(3):405-11. [QxMD MEDLINE Link].
Hamp T, Fridrich P, Mauritz W, Hamid L, Pelinka LE. Cholecystitis after trauma. J Trauma. 2009 Feb. 66(2):400-6. [QxMD MEDLINE Link].
Basar O, Kisacik B, Bozdogan E, et al. An unusual cause of acalculous cholecystitis during pregnancy: hepatitis A virus. Dig Dis Sci. 2005 Aug. 50(8):1532. [QxMD MEDLINE Link].
Fuoti M, Pinotti M, Miceli V, et al. [Acute acalculous cholecystitis as a complication of hepatitis A: report of 2 pediatric cases] [Italian]. Pediatr Med Chir. 2008 Mar-Apr. 30(2):102-5. [QxMD MEDLINE Link].
Inagaki FF, Hara Y, Kamei M, Tanaka M, Yasuno M. Acute and chronic acalculous cholecystitis associated with aortic dissection. J Surg Case Rep. 2015 Aug 1. 2015(8):[QxMD MEDLINE Link]. [Full Text].
Gu MG, Kim TN, Song J, Nam YJ, Lee JY, Park JS. Risk factors and therapeutic outcomes of acute acalculous cholecystitis. Digestion. 2014. 90(2):75-80. [QxMD MEDLINE Link].
Wood BE, Trautman J, Smith N, Putnis S. Rare case report of acalculous cholecystitis: Gallbladder torsion resulting in rupture. SAGE Open Med Case Rep. 2019. 7:2050313X18823385. [QxMD MEDLINE Link]. [Full Text].
Joseph T, Unver K, Hwang GL, et al. Percutaneous cholecystostomy for acute cholecystitis: ten-year experience. J Vasc Interv Radiol. 2012 Jan. 23(1):83-8.e1. [QxMD MEDLINE Link].
Chung YH, Choi ER, Kim KM, et al. Can percutaneous cholecystostomy be a definitive management for acute acalculous cholecystitis?. J Clin Gastroenterol. 2012 Mar. 46(3):216-9. [QxMD MEDLINE Link].
Noh SY, Gwon DI, Ko GY, Yoon HK, Sung KB. Role of percutaneous cholecystostomy for acute acalculous cholecystitis: clinical outcomes of 271 patients. Eur Radiol. 2018 Apr. 28(4):1449-55. [QxMD MEDLINE Link].
Soria Aledo V, Galindo Iniguez L, Flores Funes D, Carrasco Prats M, Aguayo Albasini JL. Is cholecystectomy the treatment of choice for acute acalculous cholecystitis? A systematic review of the literature. Rev Esp Enferm Dig. 2017 Oct. 109(10):708-18. [QxMD MEDLINE Link]. [Full Text].
Kirkegard J, Horn T, Christensen SD, Larsen LP, Knudsen AR, Mortensen FV. Percutaneous cholecystostomy is an effective definitive treatment option for acute acalculous cholecystitis. Scand J Surg. 2015 Dec. 104(4):238-43. [QxMD MEDLINE Link].
Irani S, Baron TH, Grimm IS, Khashab MA. EUS-guided gallbladder drainage with a lumen-apposing metal stent (with video). Gastrointest Endosc. 2015 Dec. 82(6):1110-5. [QxMD MEDLINE Link].
Casillas RA, Yegiyants S, Collins JC. Early laparoscopic cholecystectomy is the preferred management of acute cholecystitis. Arch Surg. 2008 Jun. 143(6):533-7. [QxMD MEDLINE Link].
Schuld J, Glanemann M. Acute cholecystitis. Viszeralmedizin. 2015 Jun. 31(3):163-5. [QxMD MEDLINE Link].
Anderson JE, Inui T, Talamini MA, Chang DC. Cholecystostomy offers no survival benefit in patients with acute acalculous cholecystitis and severe sepsis and shock. J Surg Res. 2014 Aug. 190(2):517-21. [QxMD MEDLINE Link].
Jones MW, Ferguson T. Acalculous cholecystitis. StatPearls [Internet]. 2019 Jan 16. 2018:[QxMD MEDLINE Link]. [Full Text].

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Author

Homayoun Shojamanesh, MD Former Fellow, Digestive Diseases Branch, National Institutes of Health

Homayoun Shojamanesh, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Coauthor(s)

Praveen K Roy, MD, AGAF Clinical Assistant Professor of Medicine, University of New Mexico School of Medicine

Praveen K Roy, MD, AGAF is a member of the following medical societies: American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

John Geibel, MD, MSc, DSc, AGAF Vice Chair and Professor, Department of Surgery, Section of Gastrointestinal Medicine, Professor, Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director of Surgical Research, Department of Surgery, Yale-New Haven Hospital; American Gastroenterological Association Fellow; Fellow of the Royal Society of Medicine

John Geibel, MD, MSc, DSc, AGAF is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, Society for Surgery of the Alimentary Tract

Disclosure: Nothing to disclose.

Additional Contributors

Marco G Patti, MD Surgeon, UNC Hospitals Multispecialty Surgery Clinic

Marco G Patti, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Surgeons, American Gastroenterological Association, American Medical Association, American Surgical Association, Association for Academic Surgery, Pan-Pacific Surgical Association, Society for Surgery of the Alimentary Tract, Society of American Gastrointestinal and Endoscopic Surgeons, Southwestern Surgical Congress, Western Surgical Association

Disclosure: Nothing to disclose.