Acute acalculous cholecystitis

Abstract

Acute acalculous cholecystitis (AC) is an inflammatory process of the gallbladder, often caused by other severe diseases. The etiology is multifactorial, but the pathogenesis is in all cases a reduction in the gallbladder's emptying capacity. The mortality of AC reaches 85% without treatment. This fact makes it important to consider AC as a possible complication to major surgery, multi-trauma, and artificial ventilation. Symptoms resemble "normal" cholecystitis, but may be masked by the underlying severe disease. Fever without known focus may be the only symptom. Ultrasound, CT-scanning or cholangiography are used to verify the diagnosis, supplemented by laboratory investigations. Treatment is cholecystectomy. Percutaneous ultrasonic guided cholecystotomy is a good alternative if the diagnosis made in an early stage. The mortality is considerably reduced by early intervention.