Acalculous Cholecystitis: Is an Elective Interval Cholecystectomy Necessary

Background: Acute acalculous cholecystitis (AAC) accounts for 5-10% of cases of acute cholecystitis. The advantage of interval cholecystectomy for patients with AAC is unclear. Therefore, a retrospective analysis of patients diagnosed with AAC at our institution was performed over a 5-year period. Methods: Patients were identified via hospital coding using the keywords “acalculous cholecystitis, cholecystostomy and gall bladder perforation.” Follow-up data was obtained by performing a retrospective review of the patients' hospital records. Results: A total of 33 patients with AAC were identified and followed for a median period of 18 months. The median age at presentation was 70 (10-96) and American Society of Anesthesiologists (ASA) grade was 3 (1-5). Twenty-three patients (70%) were treated with antibiotics alone, 7 patients (21%) with percutaneous cholecystostomy and 3 patients (9%) with laparoscopic cholecystectomy. The 90-day mortality rate was 30% with significant correlation to comorbid status, as all deaths occurred in ASA grade 3-5 individuals (p = 0.020). Two patients (6%) developed recurrent AAC and were managed non-operatively. Conclusion: Antibiotics and cholecystostomy were the mainstay of AAC management, and comorbid status influenced related mortality. Our results suggest that it appears safe to avoid interval cholecystectomy in patients who recover from AAC, as they are typically high-risk surgical candidates.

[1]  A. Knudsen,et al.  Percutaneous Cholecystostomy is an Effective Definitive Treatment Option for Acute Acalculous Cholecystitis , 2015, Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society.

[2]  D. Oleynikov,et al.  Acute acalculous cholecystitis in the critically ill: risk factors and surgical strategies , 2015, Langenbeck's Archives of Surgery.

[3]  D. Oleynikov,et al.  Emergent cholecystostomy is superior to open cholecystectomy in extremely ill patients with acalculous cholecystitis: a large multicenter outcome study. , 2013, American journal of surgery.

[4]  Soumitra R. Eachempati,et al.  Acute acalculous cholecystitis , 2003, Current gastroenterology reports.

[5]  S. Schenker,et al.  Acute acalculous cholecystitis: a review. , 2010, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[6]  Masahiro Yoshida,et al.  Unusual cases of acute cholecystitis and cholangitis: Tokyo Guidelines , 2007, Journal of hepato-biliary-pancreatic surgery.

[7]  H. Taoka Experimental study on the pathogenesis of acute acalculous cholecystitis, with special reference to the roles of microcirculatory disturbances, free radicals and membrane-bound phospholipase A2 , 1991, Gastroenterologia Japonica.

[8]  J. Laurila,et al.  Organ system dysfunction following open cholecystectomy for acute acalculous cholecystitis in critically ill patients , 2006, Acta anaesthesiologica Scandinavica.

[9]  Y. Mishima,et al.  Postoperative acute cholecystitis: A collective review of 494 cases in Japan , 2006, The Japanese journal of surgery.

[10]  J. Laurila,et al.  Histopathology of acute acalculous cholecystitis in critically ill patients , 2005, Histopathology.

[11]  Joseph C. Young,et al.  Ultrasonographic findings in acute acalculous cholecystitis , 2005, Gastrointestinal Radiology.

[12]  S. Bickston,et al.  Acute Acalculous Cholecystitis Associated with Systemic Sepsis and Visceral Arterial Hypoperfusion: A Case Series and Review of Pathophysiology , 2003, Digestive Diseases and Sciences.

[13]  S. Shih,et al.  Clinical predictors of severe gallbladder complications in acute acalculous cholecystitis. , 2003, World journal of gastroenterology.

[14]  C. Auboyer,et al.  Contribution of ultrasonography and cholescintigraphy to the diagnosis of acute acalculous cholecystitis in intensive care unit patients , 2000, Intensive Care Medicine.

[15]  J. Landercasper,et al.  Effective use of percutaneous cholecystostomy in high-risk surgical patients: techniques, tube management, and results. , 1999, Archives of surgery.

[16]  P. Choban,et al.  Acute acalculous cholecystitis: incidence, risk factors, diagnosis, and outcome. , 1998, The American surgeon.

[17]  T. Helbich,et al.  Sonomorphology of the gallbladder in critically ill patients , 1997, Acta radiologica.

[18]  C. Lillehei,et al.  Acalculous cholecystitis in children. , 1996, Journal of pediatric surgery.

[19]  D. Kaminski,et al.  The production of experimental cholecystitis by endotoxin. , 1994, Prostaglandins.

[20]  R. R. Babb Acute acalculous cholecystitis. A review. , 1992, Journal of clinical gastroenterology.

[21]  田岡 大樹 Experimental study on the pathogenesis of acute acalculous cholecystitis, with special reference to the roles of microcirculatory disturbances, free radicals and membrane-bound phospholipase A[2] , 1991 .

[22]  C. Andrus,et al.  The role of prostanoids in the production of acute acalculous cholecystitis by platelet-activating factor. , 1990, Annals of surgery.

[23]  E. Cornwell,et al.  Acute acalculous cholecystitis in critically injured patients. Preoperative diagnostic imaging. , 1989, Annals of surgery.

[24]  P. Fabri,et al.  Cholescintigraphy in the critically III , 1988 .

[25]  P. Fabri,et al.  Cholescintigraphy in the critically ill. , 1988, American Journal of Surgery.

[26]  A. Gottschalk,et al.  Focal acute acalculous cholecystitis. , 1987, AJR. American journal of roentgenology.

[27]  S. Mirvis,et al.  CT diagnosis of acalculous cholecystitis. , 1987, Journal of computer assisted tomography.

[28]  A. W. Nelson,et al.  The diagnosis of acute acalculous cholecystitis: a comparison of sonography, scintigraphy, and CT. , 1986, AJR. American journal of roentgenology.

[29]  T. Rudd,et al.  Low sensitivity of sonography and cholescintigraphy in acalculous cholecystitis. , 1984, AJR. American journal of roentgenology.

[30]  D. Hopwood,et al.  Gallbladder epithelial acid hydrolases in human cholecystitis , 1983, The Journal of pathology.

[31]  H. Pitt,et al.  Gallbladder disease in patients on long-term parenteral nutrition. , 1983, Gastroenterology.

[32]  E. Deitch,et al.  Acute acalculous cholecystitis. Ultrasonic diagnosis. , 1981, American journal of surgery.

[33]  Deitch Ea,et al.  Ultrasonic detection of acute cholecystitis with pericholecystic abscesses. , 1981 .

[34]  E. Deitch,et al.  Ultrasonic detection of acute cholecystitis with pericholecystic abscesses. , 1981, The American surgeon.

[35]  E. Deitch,et al.  Ultrasound in elective biliary tract surgery. , 1980, American journal of surgery.

[36]  J. Hedley-Whyte,et al.  Continuous positive-pressure ventilation and choledochoduodenal flow resistance. , 1975, Journal of applied physiology.