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Acute acalculous cholecystitis. An increasing entity

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    Acute acalculous cholecystitis (AAC) incidence significantly rose from 1950-1979, carrying a mortality rate double that of gallstone-related cholecystitis. Early surgical intervention is crucial for this condition.

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    Area of Science:

    • Gastroenterology
    • Surgical Pathology
    • Vascular Biology

    Background:

    • Acute acalculous cholecystitis (AAC) is gallbladder inflammation without stones.
    • Historically, AAC has been less common than calculous cholecystitis.
    • Understanding AAC's changing epidemiology and pathophysiology is critical.

    Observation:

    • A statistically significant increase in AAC frequency was observed between 1950 and 1979.
    • This rise was most pronounced from 1965 to 1979.
    • AAC is associated with severe clinical conditions like sepsis, trauma, and debilitation.

    Findings:

    • AAC exhibits a mortality rate more than twice that of acute calculous cholecystitis.
    • Histologically, AAC involves intense vascular injury in the gallbladder wall.
    • This vascular damage resembles experimental findings related to factor XII activation.

    Implications:

    • The intense vascular injury in AAC can lead to rapid progression to gangrene and perforation.
    • Prompt surgical treatment is essential for managing AAC.
    • Increased recognition of AAC may be linked to evolving surgical practices over the past 50 years.