Acalculous cholecystitis

Life threatening condition that occurs in critically ill patients.

• Due to poor perfusion.
• Cystic artery is an end-organ artery with no collaterals.
• Thought to be due to microvascular occlusion of end arteries within wall resulting in ischaemia.
• Risk factors:
  • Severe trauma
  • Burns
  • Major surgery
  • Prolonged fasting
  • TPN, sepsis
  • Diabetes
  • Atherosclerotic disease
  • Systemic vasculitis
  • Acute renal failure
  • AIDS.
• Diagnosis:
  • Often hindered by obtundation, presence of pre-existing diseases or recent surgery.
  • USS confirms diagnosis.
• Management:
  • Percutaneous cholecystostomy
    • Reduces tension on the wall.
    • Preferred alternative to cholecystectomy in the treatment of critically unwell patients.
  • Early cholecystectomy
    • May be appropriate depending on patient condition and if failure to improve with cholecystostomy
    • Risk of gangrene and perforation of gallbladder.