Pathophysiology and diagnosis of acute acalculous cholecystitis

Abstract

Acute acalculous cholecystitis (AAC) is an acute necro-inflammatory infection of the gallbladder in the absence of cholelithiasis, sludge, or cystic duct obstruction that occurs more often in critically ill patients with predisposing multifactorial risk factors. Although not completely understood, the pathogenesis of AAC is related to blood stasis and ischemia of the gallbladder wall, usually related to hypoperfusion; this lead to a local inflammatory response that induces necrosis of the gallbladder wall. Ultrasound is the main diagnostic tool, being repeatable, noninvasive, cost-effective, and bedside available. Diagnosis must be prompt, otherwise mortality increases significantly. However, this condition is very difficult to diagnose and should be screened in all critically ill or injured patients with sepsis, especially in cases where the cause of sepsis is not clear, in case of hypoperfusion, onset of jaundice, and/or postoperative setting.