Acalculous cholecystitis

Precipitating 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).

Ans. (a) Diabetes mellitus (b) Total parenteral nutrition (c) Tuberculosis 

• In acalculous cholecystitis, there is acute inflammation of gallbladder without gallstones.
• In over 50% of cases of acalculous cholecystitis an underlying explanation is not found.
• Acalculous cholecystitis typically develop in critically ill patients in the ICU. Patients on parenteral hyperalimentation with extensive burns, sepsis, major operations, multiple trauma or prolonged illness with multiple organ system failure are at risk for developing acalculous cholecystitis.
• Harrison writes
• “An increased risk for the development of acalculous cholecystitis is especially associated with serious trauma or burns, with the postpartum period following prolonged labor, and with orthopedic and other nonbiliary major surgical operations in the post operative period. It may possibly complicate periods of prolonged parenteral hyperalimentation. For some of these cases, biliary sludge in the cystic duct may be responsible. Other precipitating factors include
– vasculitis
– obstructing adenocarcinoma of the gall bladder
– diabetes mellitus
– torsion of the gall bladder
– unusual bacterial infections of the gall bladder (eg. Leptospira, Streptococcus, Salmonella, or Vibrio cholera), and
parasitic infestation of gallbladder.
• Acalculous cholecystitis may also be seen with a variety of other systemic disease processes
– sarcoidosis – syphilis
– cardiovascular disease – actinomycosis
– tuberculosis
• Clinical manifestation
– is indistinguishable from those of calculuos cholecystitis, however, the setting of cholecystitis in severe underlying illness is characteristic of acalculous cholecystitis.
• U/S & CT examinations show a large, tense, static gallbladder without stones and with evidence of poor emptying over a prolonged period. Ultrasonography is usually the diagnostic test of choice, as it can be done bedside in the intensive care unit.
• Management
The complication rate of acalculous cholecystitis is more than calculous cholecystitis.
– Acalculous cholecystitis requires urgent intervention.
– Percutaneous ultrasound or CT guided cholecystostomy is the treatment of choice for these patients, as they are unfit for surgery.
– If the diagnosis is uncertain, percutaneous cholecystostomy is both diagnostic and therapeutic. About 90% of patients will improve with the percutaneous cholecystostomy. However, if they do not improve, other steps, such as open cholecystostomy or cholecystectomy, may be required.
If needed cholecystectomy can be done after the patient has recovered from the underlying disease.

Ans. is ‘d’ i.e. Malaria 

Both Dengue and malaria are uncommon causes of acalculous cholecystitis.

But Malaria seems to be more uncommon between the two.

• Only two cases have so far been reported which establishes the association between malaria and acalculous cholecystitis.

Dengue and acalculous cholecystitis

Several cases of acalculous cholecystitis have been reported all over the world in patients with Dengue

A report published from a Taiwan Hospital has shown that there is definite association between Dengue and acalculous cholecystitis.

Ans. is ‘d’ i.e., Cholecystectomy is not indicated