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Aetiology, diagnosis and management for ischaemic cholecystitis: current perspectives
Juan Gerardo Favela1, Madison B Argo1, Sergio Huerta2,3
1Department of Surgery, University of Wisconsin, Madison, Wisconsin, USA.
Insights
Ischaemic cholecystitis, a severe gallbladder inflammation from poor blood flow, is distinct from other acalculous cholecystitis. Early differentiation is crucial for better outcomes in critically ill patients.
Area of Science:
- Gastroenterology
- Critical Care Medicine
- Surgical Pathology
Background:
- Acalculous cholecystitis lacks gallstones but encompasses diverse causes.
- Hypoperfusion can cause gallbladder inflammation, ischemia, and perforation, termed ischaemic cholecystitis.
- This condition is prevalent in critically ill patients, posing unique challenges.
Purpose of the Study:
- Introduce and define ischaemic cholecystitis.
- Differentiate it from other forms of acalculous cholecystitis.
- Highlight its distinct diagnostic and therapeutic implications in critical care.
Main Methods:
- Literature review and conceptual framework development.
- Analysis of clinical presentations and outcomes.
- Discussion of diagnostic modalities and treatment strategies.
Main Results:
- Ischaemic cholecystitis has higher morbidity and mortality than other acute cholecystitis forms.
- Diagnostic and treatment challenges are specific to the critical care setting.
- Current terminology inadequately distinguishes this entity.
Conclusions:
- Ischaemic cholecystitis is a critical subtype of acute gallbladder inflammation.
- Distinguishing it from other acalculous cholecystitis is vital for patient management.
- Further research into specific diagnostic and treatment protocols is warranted.
Abstract:
In the absence of gallstones or any other form of mechanical obstruction, hypoperfusion to the gallbladder can lead to inflammation, ischaemia and perforation. This constellation of findings has historically been simply referred to as 'acalculous cholecystitis'. However, this term makes no distinction between inflammation due to critical illness and poor perfusion, or what we will refer to as ischaemic cholecystitis, versus other non-obstructive aetiologies. Ischaemic cholecystitis presents diagnostic as well as treatment challenges that are unique to patients in the critical care setting. More importantly, the morbidity and mortality of this proposed subcategory of acute gallbladder inflammation is much higher compared with other forms of acute cholecystitis. In the present manuscript, we introduce the concept of ischaemic cholecystitis and the importance of differentiating this clinical diagnosis from other forms of acalculous cholecystitis. Additionally, we elaborate on the most recent diagnostic modalities and treatment options specific to this vulnerable patient population.
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