Acalculous Cholecystitis: Is an Elective Interval Cholecystectomy Necessary

Abstract

Background: Acute acalculous cholecystitis (AAC) accounts for 5-10% of cases of acute cholecystitis. The advantage of interval cholecystectomy for patients with AAC is unclear. Therefore, a retrospective analysis of patients diagnosed with AAC at our institution was performed over a 5-year period. Methods: Patients were identified via hospital coding using the keywords “acalculous cholecystitis, cholecystostomy and gall bladder perforation.” Follow-up data was obtained by performing a retrospective review of the patients' hospital records. Results: A total of 33 patients with AAC were identified and followed for a median period of 18 months. The median age at presentation was 70 (10-96) and American Society of Anesthesiologists (ASA) grade was 3 (1-5). Twenty-three patients (70%) were treated with antibiotics alone, 7 patients (21%) with percutaneous cholecystostomy and 3 patients (9%) with laparoscopic cholecystectomy. The 90-day mortality rate was 30% with significant correlation to comorbid status, as all deaths occurred in ASA grade 3-5 individuals (p = 0.020). Two patients (6%) developed recurrent AAC and were managed non-operatively. Conclusion: Antibiotics and cholecystostomy were the mainstay of AAC management, and comorbid status influenced related mortality. Our results suggest that it appears safe to avoid interval cholecystectomy in patients who recover from AAC, as they are typically high-risk surgical candidates.

Percutaneous cholecystostomy as a definitive treatment for moderate and severe acute acalculous cholecystitis: a retrospective observational study

“…All patients had moderate-to-severe AC in our study, which further confirmed that PC is a technically safe choice. The recurrence rate after treatment with PC alone was 22.2% (6/27), which was significantly higher than the rates of 8.6% reported in the study of Abbas [ 8 ] and 2.7% reported in the study of Noh [ 7 ] but lower than the rate of 40% (2/5) reported in the study of Polistina [ 20 ]. Compared with the study of Noh, the high recurrence rate observed in our study may be related to the exclusion of Grade I AAC patients.…”

Gastrointestinal complications following on-pump cardiac surgery—A propensity matched analysis

“…Interestingly, only two patients had pre-existing asymptomatic cholecystolithiasis. Uncomplicated cases of postoperative cholecystitis could be managed with antibiotic treatment only [21]; in other cases laparoscopic cholecystectomy or open cholecystectomy were the treatments of choice, with percutaneous cholecystostomia as a definitive or bridge therapy in only two cases.…”

Acute cholecystitis secondary to dog bite

“…Based on this case, we would encourage consideration of prolonged antibiotics in cases of acalculous cholecystitis that could be secondary to c. canimorsus bacteremia. Given the risk of recurrence of this illness is very low, interval cholecystectomy is considered unnecessary in patients who recovery from acute acalculous cholecystitis [17].…”