What is Acalculous Cholecystitis?
Acalculous Cholecystitis is a medical condition in which there is inflammation of the gallbladder but without the presence of any gallstones. Cholecystitis is the term used for inflammation of gallbladder as a result of stones either in the gallbladder or in the bile duct and is termed as calculous Cholecystitis but in Acalculous Cholecystitis there is no presence of any stones either in the gallbladder or in the bile duct.
Acalculous Cholecystitis is not as common as acute cholecystitis or calculous Cholecystitis but the complications that arise due to Acalculous Cholecystitis are far more severe and life threatening than those of acute or calculous Cholecystitis. In the United States it is estimated that about 10% of people suffer from Acalculous Cholecystitis.
This condition usually occurs in people who are acutely ill due to some other underlying medical condition and are severely debilitated. This causes the impairment of blood circulation to the gallbladder resulting in ischemia and eventually Acalculous Cholecystitis. Infection is yet another cause for Acalculous Cholecystitis.
What Causes Acalculous Cholecystitis?
As stated, Acalculous Cholecystitis usually occurs in people who are severely ill and debilitated due to some underlying medical condition. This results in impairment of blood circulation through the gallbladder causing ischemia with resultant Acalculous Cholecystitis.
Another cause for Acalculous Cholecystitis is that critically ill people are not able to eat food normally and hence the ability of the gallbladder to contract and release bile is severely compromised resulting in Acalculous Cholecystitis.
Gallbladder dysmotility is also seen in pregnant females and people who have liver dysfunction and is yet another cause for Acalculous Cholecystitis. Acalculous Cholecystitis may also be caused as a result of an infection.
What are the Symptoms of Acalculous Cholecystitis?
The presenting features or symptoms of Acalculous Cholecystitis is similar to that of calculous Cholecystitis, although people who have Acalculous Cholecystitis are themselves severely ill with some other medical condition and the symptoms of that condition may present themselves more than those of Acalculous Cholecystitis.
Some people may be so sick that they may be unable to tell the physician about any symptoms that may be caused due to Acalculous Cholecystitis and hence the only presenting feature that may point towards Acalculous Cholecystitis is a distended abdomen along with fever.
In some cases even these symptoms may be similar to the medical condition the individual may be suffering from and hence it becomes difficult to definitively tell that the symptoms are that of Acalculous Cholecystitis.
Some of the pertinent features or symptoms of Acalculous Cholecystitis are:
- Fever of unknown etiology
- Abdominal distension
- Abdominal tenderness
- Pain in the abdomen and right upper quadrant
- Loss of appetite
- Weakness and lethargy
How is Acalculous Cholecystitis Diagnosed?
There may be numerous investigations that may be performed to identify the cause of Acalculous Cholecystitis but none of them can give a confirmatory diagnosis of Acalculous Cholecystitis. If Acalculous Cholecystitis is suspected in a patient then the following studies are conducted:
- Ultrasound of the right upper quadrant and abdominal area which will clearly reveal inflammation
- CT scan of the abdomen
- HIDA scan
These tests are basically done to rule in or rule out presence of gallstones, detect the presence of any complications, severity of the condition and confirm the diagnosis of Acalculous Cholecystitis.
How is Acalculous Cholecystitis Treated?
Since majority of the cases of Acalculous Cholecystitis occur in patients who are already severely ill hence treatment is usually done in an inpatient setting. The patient is administered intravenous fluids. Pain management is something which is usually avoided especially in critically ill patients and so is the use of antibiotics unless there is presence of stones along with bacterial infection.
The front line treatment for Acalculous Cholecystitis is surgical removal of the gallbladder; however, a patient with Acalculous Cholecystitis may be so ill that he or she may be not in a state to undergo such a procedure. Thus the patients are treated with:
- Gallbladder stent placement which is done endoscopically
- Percutaneous cholecystostomy
The above procedures facilitate drainage of the gallbladder directly into the duodenum or eliminated through the body via catheter. Once the patient is stabilized and improved enough to undergo surgery the gallbladder is completely removed to treat Acalculous Cholecystitis. Cholecystectomy for Acalculous Cholecystitis is an absolute necessity since the complications may be severe and life threatening for the patient suffering from Acalculous Cholecystitis.
- Mayo Clinic: Gallbladder (Acalculous Cholecystitis) – https://www.mayoclinic.org/diseases-conditions/gallbladder-cancer/symptoms-causes/syc-20353378
- StatPearls: Acalculous Cholecystitis – https://www.ncbi.nlm.nih.gov/books/NBK507863/