Cholecystitis in the absence of gallstones

Acalculous cholecystitis (AC) is inflammation of the gallbladder in the absence of stones:

• accounts for approximately 10% of all cases of acute cholecystitis
• it may be acute or chronic and, is clinically indistinguishable from acute calculous cholecystitis
• common in males, but children can be affected after severe viral infection (2)

Aetiology is multifactorial but the following risk factors have been identified:

• trauma: leading to hospitalization
• recent surgery (unrelated to GB, abdominal, or extra-abdominal)
• shock of any kind
• critical illness (any patient requiring ICU care)
• burns
• sepsis
• infections – Brucellosis, Q fever, leptospirosis, Plasmodium falciparum and vivax
• prolonged fasting

Diagnosis is difficult because no clinical finding is specific for the condition. Hence a high degree of clinical suspicion for AC is indicated (1). This should be combined with imaging which usually consists of ultrasound and HIDA (1).

Complications (gangrene, empyema, and perforation) are more common than in calculous cholecystitis (2).

Available treatment options for AC are:

• cholecystostomy/percutaneous cholecystostomy
  • ideally should be carried out immediately
  • an accepted alternative to cholecystectomy
  • patient may improve with this alone or may require a cholecystectomy
• cholecystectomy
  • either open or laparoscopic surgery
  • considered as definitive therapy

Reference:

1. Huffman JL, Schenker S. Acute acalculous cholecystitis: a review. Clin Gastroenterol Hepatol. 2010;8(1):15-22
2. Elwood DR. Cholecystitis. Surg Clin North Am. 2008;88(6):1241-52