Recent advances in management of acalculous cholecystitis

Abstract

Acalculous cholecystitis is a life-threatening gallbladder infection that typically affects the critically ill. A late diagnosis can have devastating outcomes because of the high risk of gallbladder perforation if untreated. The diagnosis is not straightforward as Murphy’s sign is difficult to illicit in the critically ill and many imaging findings are either insensitive or non-specific. This article reviews the current imaging literature to improve the interpretation of findings. Management involves a percutaneous cholecystostomy, surgical cholecystectomy, or more recently an endoscopically placed metal stent through the gastrointestinal tract into the gallbladder. This article reviews the current literature assessing the outcomes of each treatment option and suggests a protocol in determining the modality of choice on the basis of patient population. Specifically, endoscopic ultrasound-guided gallbladder drainage is a novel drainage approach for patients who are poor candidates for surgery and obviates the need for a percutaneous drain and all its complications. It has promising results but has caveats in its uses.

Diagnosis and management of acute acalculous cholecystitis in an outpatient: a case report

“…Acalculous cholecystitis typically affects elderly males whereas gallstone disease affects young female. 3 Our patient is a middle-aged gentleman, hypertensive and on tablet Valsartan. He is not diabetic and no coexisting cardiovascular disease.…”

Acute acalculous cholecystitis on a COVID-19 patient: a case report

“…Acalculous cholecystitis is an uncommon disease caused by hypomotility of the gallbladder which is responsible of increased intraluminal pressures evolving in inflammation, ischemia and necrosis [ 5 ]. It accounts for only 10% of acute cholecystitis but it has higher morbidity and mortality than calculous cholecystitis [ 6 , 7 ].…”

“…It accounts for only 10% of acute cholecystitis but it has higher morbidity and mortality than calculous cholecystitis [ 6 , 7 ]. Acalculous cholecystitis is also strictly related with other pathological condition such as trauma, cardiopulmonary resuscitation, mechanical ventilation, sepsis, burn, prolonged total parenteral nutrition and major surgery [ 5 ]. In addition, Croteau et al reported seven cases of acute acalculous cholecystitis occurred in patients with relapsing - remitting multiple sclerosis during or shortly after alemtuzumab treatment, suggesting an acute cytokine release syndrome as a pathogenic mechanism [ 8 ].…”

Acute acalculous cholecystitis on a COVID-19 patient: a case report

“…Acalculous cholecystitis is an uncommon disease caused by hypomotility of the gallbladder which is responsible of increased intraluminal pressures evolving in in ammation, ischemia and necrosis 4 . It accounts for only 10% of acute cholecystitis but it has higher morbidity and mortality than calculous cholecystitis [5][6] .…”

“…It accounts for only 10% of acute cholecystitis but it has higher morbidity and mortality than calculous cholecystitis [5][6] . Acalculous cholecystitis is also strictly related with other pathological condition such as trauma, cardiopulmonary resuscitation, mechanical ventilation, sepsis, burn, prolonged total parenteral nutrition and major surgery 4 . In addition, Croteau et al reported seven cases of acute acalculous cholecystitis occurred in patients with relapsing -remitting multiple sclerosis during or shortly after alemtuzumab treatment, suggesting an acute cytokine release syndrome as a pathogenic mechanism 7 .…”