S Kumar, Yushak Abdul Wahab and Yunus Alif Gui
Department of Surgery, Universiti Putra Malaysia, 43400, Serdang, Selangor.
Correspondence: YA Gul; e-mail:
CITATION: S Kumar, Yushak Abdul Wahab, Yunus Alif Gui. Acalculous cholecystitis-a review. International Medical Research Journal. 2002;6(I):1–10.
ABSTRACT
Acute acalculous cholecystitis (AAC) may develop in critically ill or injured patients including children. This condition, which is basically acute cholecystitis without gallstones as an aetiological factor, is an uncommon but serious illness and appears to be increasing in incidence. Chronic acalculous cholecystitis (CAC) is a clinical entity characterized by recurrent postprandial biliary colic in patients with sonographically normal gallbladders and low ejection fraction by quantitative radionuclide scanning of the biliary tree following cholecystokinin administration. The development of AAC is not Iimited to surgical or injured patients, or even to the intensive care unit. Other aetiological factors include diabetes mellitus, malignant tumours of several types. abdominal vasculitis, congestive heart failure, cholesterol embolization. and shock. The pathogenesis of AAC is a paradigm of complexity. Though bile stasis, opioid therapy, positive-pressure ventilation, and total parenteral nutrition have all been implicated, ischaemia-reperfusion injury, or the effects of eicosanoid proinflammatory mediators appear to be the central triggering mechanisms. Ultrasound of the gallbladder is the most accurate diagnostic modality in the critically ill patient, with gallbladder wall thickness of 3.5 mm or greater and pericholecystic fluid being the two most reliable criteria. The mainstay of therapy for AAC has been cholecystectomy, but percutaneous cholecystostomy is gaining acceptance as an alternative to open procedures. Chronic acalculous cholecystitis is a diagnosis of exclusion and usually managed by laparoscopic cholecsystectomy with overall results being similar to those operated upon for calculous disease. The current review encompasses both acute and chronic clinical entities with an emphasis on their pathogenesis and current management concepts.
KEYWORDS: acalculous, cholecystitis, gallbladder, acute, chronic
