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Acute acalculous cholecystitis

R J Howard

    American Journal of Surgery
    |February 1, 1981
    PubMed
    Summary
    This summary is machine-generated.

    Acute cholecystitis can occur without gallstones, particularly after surgery or trauma. This condition, known as acalculous cholecystitis, shares symptoms with gallstone-induced cases and can lead to severe complications.

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    Area of Science:

    • Gastroenterology
    • Surgical Pathology

    Background:

    • Acute cholecystitis is commonly associated with gallstones (cholelithiasis).
    • Acalculous cholecystitis, inflammation of the gallbladder without stones, is less understood but recognized in specific patient populations.

    Purpose of the Study:

    • To investigate the clinical characteristics, outcomes, and potential contributing factors of acute cholecystitis in patients without gallstones.
    • To compare the presentation and severity of acalculous cholecystitis with calculous cholecystitis.

    Main Methods:

    • Retrospective analysis of 63 patients diagnosed with acute cholecystitis but lacking gallstones.
    • Review of patient histories, clinical signs and symptoms, operative findings, and microbiological data.
    • Correlation of clinical scenarios (postoperative, trauma) with the incidence of acalculous cholecystitis.

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    Main Results:

    • 49 men and 14 women presented with acute cholecystitis without gallstones.
    • 17 cases occurred postoperatively, and 7 followed extensive trauma.
    • Symptoms were similar to gallstone-associated cholecystitis; gangrene (47.6%) and perforation (5 cases) were significant complications. E. coli was the most common pathogen in bile cultures.

    Conclusions:

    • Acute acalculous cholecystitis has a high incidence in postoperative patients, those with trauma, and children.
    • Pathophysiological factors likely include decreased gallbladder perfusion (due to shock, heart failure, arteriosclerosis), cystic duct obstruction, and concentrated bile.
    • The clinical presentation and severity of acalculous cholecystitis necessitate prompt recognition and management, similar to its calculous counterpart.