Acalculous Cholecystitis

Synonyms

Cholecystitis

Definition

Acalculous cholecystitis (ACC) was first reported in 1844 in a patient who just underwent a femoral hernia repair. It is a rare, yet severe, and potentially fatal condition affecting critically ill and trauma patients. ACC is defined as inflammation of the gallbladder without calculi (Crichlow et al. 2012). Ultrasound examination of the abdomen has been shown to be the most accurate diagnosis of ACC in critically ill patients. Thickening of the gallbladder wall to 3 mm has 90 % specificity, and 100 % sensitivity while a wall thickness of 3.5 mm has 98.5 % specificity and 80 % sensitivity. The other major criteria for identifying ACC include gallbladder wall edema, sonographic murphy’s sign (which may be difficult if the patient is obtunded), pericholecystic fluid, mucosal sloughing, and intramural gas. Sludge, nonshadowing stones, cholesterolosis, hypoalbuminemia, or ascites can mimic a thickened gallbladder causing a false-positive reading (Barie and...