eMedicine Specialties > Gastroenterology > Biliary

Acalculous Cholecystitis: Treatment & Medication

Author: Homayoun Shojamanesh, MD, Former Fellow, Digestive Diseases Branch, National Institutes of Health
Coauthor(s): Praveen K Roy, MD, Comments and Criticisms Editor, Cochrane Colorectal Cancer Group
Contributor Information and Disclosures

Updated: Aug 27, 2009

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

References

  1. Theodorou P, Maurer CA, Spanholtz TA, Phan TQ, Amini P, Perbix W, et al. Acalculous cholecystitis in severely burned patients: incidence and predisposing factors. Burns. May 2009;35(3):405-11. [Medline].

  2. Hamp T, Fridrich P, Mauritz W, Hamid L, Pelinka LE. Cholecystitis after trauma. J Trauma. Feb 2009;66(2):400-6. [Medline].

  3. 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].

  4. Fuoti M, Pinotti M, Miceli V, et al. [Acute acalculous cholecystitis as a complication of hepatitis A: report of 2 pediatric cases] [Italian]. Pediatr Med Chir. Mar-Apr 2008;30(2):102-5. [Medline].

  5. Casillas RA, Yegiyants S, Collins JC. Early laparoscopic cholecystectomy is the preferred management of acute cholecystitis. Arch Surg. Jun 2008;143(6):533-7. [Medline].

  6. Babb RR. Acute acalculous cholecystitis. A review. J Clin Gastroenterol. Oct 1992;15(3):238-41. [Medline].

  7. Barie PS, Fischer E. Acute acalculous cholecystitis. J Am Coll Surg. Feb 1995;180(2):232-44. [Medline].

  8. Boland G, Lee MJ, Mueller PR. Acute cholecystitis in the intensive care unit. New Horiz. May 1993;1(2):246-60. [Medline].

  9. Boland GW, Lee MJ, Dawson SL, Mueller PR. Percutaneous cholecystostomy for acute acalculous cholecystitis in a critically ill patient. AJR Am J Roentgenol. Apr 1993;160(4):871-4. [Medline].

  10. Chung SC. Acute acalculous cholecystitis. A reminder that this condition may appear in a primary care practice. Postgrad Med. Sep 1995;98(3):199-200, 203-4. [Medline].

  11. Conway JD, Russo MW, Shrestha R. Endoscopic stent insertion into the gallbladder for symptomatic gallbladder disease in patients with end-stage liver disease. Gastrointest Endosc. Jan 2005;61(1):32-6. [Medline].

  12. Fisher RL. Hepatobiliary abnormalities associated with total parenteral nutrition. Gastroenterol Clin North Am. Sep 1989;18(3):645-66. [Medline].

  13. Hasse C, Zielke A, Nies C, et al. Influence of ceruletid on gallbladder contraction: a possible prophylaxis of acute acalculous cholecystitis in intensive care patients?. Digestion. 1995;56(5):389-94. [Medline].

  14. 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].

  15. Kageoka M, Watanabe F, Maruyama Y, et al. Long-term prognosis of patients after endoscopic sphincterotomy for choledocholithiasis. Dig Endosc. Jul 2009;21(3):170-5. [Medline].

  16. 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].

  17. 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].

  18. Lillemoe KD. Surgical treatment of biliary tract infections. Am Surg. Feb 2000;66(2):138-44. [Medline].

  19. Merrell RC, Miller-Crotchett P, Lowry P. Gallbladder response to enteral lipids in injured patients. Arch Surg. Mar 1989;124(3):301-2. [Medline].

  20. Nash JA, Cohen SA. Gallbladder and biliary tract disease in AIDS. Gastroenterol Clin North Am. Jun 1997;26(2):323-35. [Medline].

  21. Owen CC, Bilhartz LE. Gallbladder polyps, cholesterolosis, adenomyomatosis, and acute acalculous cholecystitis. Semin Gastrointest Dis. Oct 2003;14(4):178-88. [Medline].

  22. Schwesinger WH, Diehl AK. Changing indications for laparoscopic cholecystectomy. Stones without symptoms and symptoms without stones. Surg Clin North Am. Jun 1996;76(3):493-504. [Medline].

Further Reading

Related eMedicine Topics

Clinical Trials
National Guideline Clearinghouse

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

Contributor Information and Disclosures

Author

Homayoun Shojamanesh, MD, Former Fellow, Digestive Diseases Branch, National Institutes of Health
Homayoun Shojamanesh, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.

Coauthor(s)

Praveen K Roy, MD, Comments and Criticisms Editor, Cochrane Colorectal Cancer Group
Praveen K Roy, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, and Canadian Association of Gastroenterology
Disclosure: Nothing to disclose.

Medical Editor

Marco G Patti, MD, Professor of Surgery, Director, Center for Esophageal Diseases, University of Chicago Pritzker School of Medicine
Marco G Patti, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Surgeons, American Gastroenterological Association, American Medical Association, American Surgical Association, Association for Academic Surgery, Pan-Pacific Surgical Association, Society for Surgery of the Alimentary Tract, Society of American Gastrointestinal and Endoscopic Surgeons, Southwestern Surgical Congress, and Western Surgical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Michael A Grosso, MD, Consulting Staff, Department of Cardiothoracic Surgery, St Francis Hospital
Michael A Grosso, MD is a member of the following medical societies: American College of Surgeons, Society of Thoracic Surgeons, and Society of University Surgeons
Disclosure: Nothing to disclose.

CME Editor

Paolo Zamboni, MD, Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy
Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences
Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MA, Vice Chairman, Professor, Department of Surgery, Section of Gastrointestinal Medicine and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director of Surgical Research, Department of Surgery, Yale-New Haven Hospital
John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract
Disclosure: AMGEN Royalty Other

 
 
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