Acute acalculous cholecystitis in the critically ill

Acute acalculous cholecystitis, inflammation of the gallbladder without evidence of calculi, accounts for 2 to 15% of all cases of acute cholecystitis. The incidence of acute acalculous cholecystitis in adults undergoing cholecystectomy may be as high as 15 per cent and up to 32 per cent in the pediatric population. During the past 10 years, 22 patients who were being treated in the intensive care unit for other reasons underwent cholecystectomy for acute acalculous cholecystitis. Eighteen (82%) of the patients were male, the average age was 61 years, and patients spent an average of 19 days in the intensive care unit prior to cholecystectomy. The most common clinical findings were right upper quadrant tenderness and pain. Fifteen (68%) of the patients had a previous operative procedure. HIDA scans were positive in all 12 patients in which they were performed. Ultrasounds were positive in 13 of 17 (76%) patients, and CT scans 7 of 9 (78%). Nine (41%) patients died. Early diagnosis with rapid intervention is crucial in managing this disease if outcome is to be improved. Gangrene and/or necrosis of the gallbladder was present in 13 (59%) of patients, suggesting that cholecystectomy may be the best approach to management.