Fact-sheet: Acute acalculous cholecystitis
Updated on 04/19/2018 at 4:31 PM
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Definition
Accounts for 5 to 15% of all acute cholecystitis cases.
Occurs mainly in a setting of immunosuppression or ICU hospitalization (50% of cases).
Form of acute cholecystitis secondary to gallbladder infarction, potentially severe as it can rapidly progress to gallbladder gangrene.
Clinical features
Variable clinical presentation:
-classic acute cholecystitis picture
-asymptomatic, incidentally discovered on imaging
-unexplained systemic sepsis
Laboratory findings
Biological inflammatory syndrome, but may be absent in cases of immunosuppression.
Ultrasound
- Distended gallbladder with a layered wall and thick but acalculous content
- Respiratory arrest on probe pressure over the gallbladder (sonographic Murphy sign)
CT
- Gallbladder distension
- Irregular wall with variable enhancement after injection related to ischemic changes
- Hepatic perfusion abnormalities adjacent to the gallbladder
- Pericholecystic fat infiltration
- No intraluminal gallstone detected (better assessed on ultrasound)
Management
Ultrasound-guided percutaneous cholecystostomy.
Differential diagnosis
Other forms: acute calculous cholecystitis, emphysematous cholecystitis.