eMedicine Specialties > Gastroenterology > Biliary
Acalculous Cholecystitis: Treatment & Medication
Updated: Aug 27, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Treatment
Medical Care
When the diagnosis of acalculous cholecystitis is established, immediate intervention is indicated because of the high risk of rapid deterioration and gallbladder perforation.
In patients with acalculous cholecystitis who are high-risk surgical candidates (ie, end-stage liver disease), endoscopic gallbladder stent placement has been reported as an effective palliative treatment. This involves placement of a double pigtail stent between the gallbladder and the duodenum during endoscopic retrograde cholangiopancreatography (ERCP). However, the definitive treatment of acalculous cholecystitis is cholecystectomy for patients who are able to tolerate surgery.
Surgical Care
In surgical candidates, open or laparoscopic cholecystectomy is indicated.5 In patients who are not surgical candidates, percutaneous cholecystostomy may be performed in the radiology suite. Catheters are usually removed after approximately 3 weeks in critically ill patients with acalculous cholecystitis who have undergone percutaneous cholecystostomy. This allows for the development of a mature track from the skin to the gallbladder.
Consultations
- Gastroenterologists
- Surgeons
- Radiologists
Diet
Patients in the acute stage of acalculous cholecystitis should receive nothing by mouth. Hydration with intravenous fluids should be provided.
Medication
Administer broad-spectrum antibiotics for enteric and biliary pathogen coverage. Definitive treatment is cholecystectomy in patients who are surgical candidates or cholecystostomy in patients who are not surgical candidates.
More on Acalculous Cholecystitis |
| Overview: Acalculous Cholecystitis |
| Differential Diagnoses & Workup: Acalculous Cholecystitis |
Treatment & Medication: Acalculous Cholecystitis |
| Follow-up: Acalculous Cholecystitis |
| References |
| Further Reading |
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References
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Basar O, Kisacik B, Bozdogan E, et al. An unusual cause of acalculous cholecystitis during pregnancy: hepatitis A virus. Dig Dis Sci. Aug 2005;50(8):1532. [Medline].
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Fisher RL. Hepatobiliary abnormalities associated with total parenteral nutrition. Gastroenterol Clin North Am. Sep 1989;18(3):645-66. [Medline].
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Hatada T, Kobayashi H, Tanigawa A, et al. Acute acalculous cholecystitis in a patient on total parenteral nutrition: case report and review of the Japanese literature. Hepatogastroenterology. Jul-Aug 1999;46(28):2208-11. [Medline].
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Lameris JS, van Overhagen H. Imaging and intervention in patients with acute right upper quadrant disease. Baillieres Clin Gastroenterol. Mar 1995;9(1):21-36. [Medline].
Lee SW, Yang SS, Chang CS, Yeh HJ. Impact of the Tokyo guidelines on the management of patients with acute calculous cholecystitis. J Gastroenterol Hepatol. Aug 3 2009;epub ahead of print. [Medline].
Lillemoe KD. Surgical treatment of biliary tract infections. Am Surg. Feb 2000;66(2):138-44. [Medline].
Merrell RC, Miller-Crotchett P, Lowry P. Gallbladder response to enteral lipids in injured patients. Arch Surg. Mar 1989;124(3):301-2. [Medline].
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Further Reading
Related eMedicine Topics
- Acalculous Cholecystopathy
- Cholecystitis [in the Gastroenterology section]
- Cholecystitis [in the Pediatrics: General Medicine section]
- Cholecystitis, Acalculous [in the Radiology section]
- Cholecystitis, Acute [in the Radiology section]
- Cholelithiasis [in the Gastroenterology section]
- Cholelithiasis [in the Radiology section]
- Acute Cholecystitis – Early Laparoscopic Surgery Versus Antibiotic Therapy and Delayed Elective Cholecystectomy (ACDC)
- Harmonic in Laparoscopic Cholecystectomy for Acute Cholecystitis (HAC)
- NOTES-Assisted Laparoscopic Cholecystectomy Surgery
- Single Port Access (SPA) Cholecystectomy Versus Standard Laparoscopic Cholecystectomy Study of Pain Perception Between Males and Females Following Laparoscopic Cholecystectomy
- ACR Appropriateness Criteria® acute abdominal pain and fever or suspected abdominal abscess. American College of Radiology - Medical Specialty Society. 1996 (revised 2006). 7 pages. NGC:005138
- ACR Appropriateness Criteria® right upper quadrant pain. American College of Radiology - Medical Specialty Society. 1996 (revised 2007). 5 pages. NGC:006992
- Diagnostic laparoscopy for acute abdominal pain. In: Diagnostic laparoscopy guidelines. Society of American Gastrointestinal and Endoscopic Surgeons - Medical Specialty Society. 1998 Apr (revised 2007 Nov). 7 pages. NGC:006830
Keywords
acalculous cholecystitis, acute cholecystitis, cholecystitis, gallbladder inflammation, inflammation of the gallbladder, gallbladder pain, total parenteral nutrition, TPN, bile stasis, gallbladder stasis, stagnant bile, gallbladder dysmotility, sepsis with biliary tract infection, AIDS cholangiopathy, TPN-associated liver disease, cholecystectomy, percutaneous cholecystostomy
Treatment & Medication: Acalculous Cholecystitis