ACALCULOUS CHOLECYSTITIS

• Acalculous cholecystitis is the inflammation of the gall bladder in the absence of the gall stone or cystic duct obstruction.
• It is a rare but a life threatening situation.

  

RISK FACTORS-

• Starvation
• Burn, surgery, trauma
• Nacrotic analegesic
• Decrease blood flow through cystic artery- artherosclerosis, cardiac failure, diabetes
• Immunocompromised disease- AIDS, candida, cholera.
• Tuberculosis
• Prolonged parenteral nutrition 
• Other factors for acalculous cholecystitis are vasculitis, obstructing adenocarcinoma of the gallbladder, diabetes mellitus, torsion of the gallbladder, “unusual” bacterial infections of the gallbladder (e.g., Leptospira, Streptococcus, Salmonella, or Vibrio cholerae).

 

PATHOGENESIS-

• MC pathology can be gallbladder stasis, ischaemia.
• Critically ill patients
• Disturbed microcirculation

 

CLINICAL FEATURES-

• Right upper quadrant abdominal pain, nausea, vomiting, fever, jaundice and abdominal mass.

 

INVESTIGATIONS-

• Ultrasound (USG)- IOC
• Gold standard investigations- HIDA scan
• Murphy’s sign is positive

  

TREATMENT-

• Laproscopic cholecystectomy
• For unstable patient- percutaneous cholecystectomy

 

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