Acute acalculous cholecystitis in hospitalized patients in intensive care unit: study of 5 cases

Acute acalculous cholecystitis (AAC) is an inflammation of the gallbladder with no evidence of gallstones. It occurs mostly in patients in intensive care units and is associated with several risk factors (fasting, parenteral nutrition, mechanical ventilation) leading to ischemia of the gallbladder wall.

This is a retrospective multiple cases study of five cases of AAC in patients hospitalized in the Medical Intensive Care Unit at Tahar Sfar Hospital in Mahdia over a 4-year period between January 2016 and December 2020.

The mean age of our patients was 62.5 years (±8) with a male predominance (sex ratio 4/1). The mean Charlson comorbidity index was 4. Four patients were under invasive mechanical ventilation and total parenteral nutrition. Three patients were under vasoactive drugs. All patients had fever, the patient who was conscious presented with abdominal pain and vomiting with right hypochondrium tenderness, while two patients presented with abdominal bloating and bowel obstruction. All patients had a biological inflammatory syndrome, two patients had cytolysis, and only one patient had cholestasis. All patients had a thickening of the gallbladder wall greater than 3mm on ultrasound. Treatment was based on broad-spectrum antibiotic therapy followed by early (<72 h) cholecystectomy. Only one patient had postoperative peritonitis. All patients had gangrenous cholecystitis. Three patients died of multi-visceral failure.

This study, in spite of its small sample size, gave us an idea of patients at risk of developing this disease, on the difficulty of diagnosis and on the importance of surgical treatment.