Show Summary Details
Page of

Acute acalculous cholecystitis in the critically ill 

Acute acalculous cholecystitis in the critically ill
Chapter:
Acute acalculous cholecystitis in the critically ill
Author(s):

Vanessa P. Ho

and Philip S. Barie

DOI:
10.1093/med/9780199600830.003.0188
Page of

PRINTED FROM OXFORD MEDICINE ONLINE (www.oxfordmedicine.com). © Oxford University Press, 2020. All Rights Reserved. Under the terms of the licence agreement, an individual user may print out a PDF of a single chapter of a title in Oxford Medicine Online for personal use (for details see Privacy Policy and Legal Notice).

date: 30 November 2020

Acute acalculous cholecystitis (AAC) may occur in surgical or injured, critically-ill, and systemically-ill patients, with diabetes mellitus, malignant disease, abdominal vasculitis, congestive heart failure, cholesterol embolization, shock, and cardiac arrest. Children may also be affected, especially following a viral illness. The pathogenesis of AAC is complex and multifactorial. Ischaemia/reperfusion injury and the associated pro-inflammatory response and oxidative tissue stress, appear to be the central mechanisms, but bile stasis, opioid therapy, positive-pressure ventilation, and parenteral nutrition may all contribute to development of the disease. Ultrasound of the gallbladder is most accurate for the diagnosis of AAC in the critically-ill patient. Computed tomography is probably of comparable accuracy, but carries both advantages and disadvantages. Percutaneous cholecystostomy is now the treatment of choice, controlling AAC in about 85% of patients, despite the known high prevalence of gallbladder infarction (~50%) and perforation (~10%). Rapid improvement may be expected when AAC is diagnosed correctly and cholecystostomy is performed timely. The mortality (historically ~30%) of percutaneous and open cholecystostomy are similar, reflecting the severity of illness, but improved resuscitation and critical care may portend a decreased risk of death.

Access to the complete content on Oxford Medicine Online requires a subscription or purchase. Public users are able to search the site and view the abstracts for each book and chapter without a subscription.

Please subscribe or login to access full text content.

If you have purchased a print title that contains an access token, please see the token for information about how to register your code.

For questions on access or troubleshooting, please check our FAQs, and if you can't find the answer there, please contact us.