Acalculous Cholecystitis Treatment & Management

  • Author: Homayoun Shojamanesh, MD; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
Updated: Sep 26, 2016

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), Gu et al reported that endoscopic gallbladder stent placement as an effective palliative treatment.[8] 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.

In selected patients with acute acalculous cholecystitis (AAC), nonsurgical treatment (such as antibiotics or percutaneous cholecystostomy) may be an effective alternative to surgery.[8] In the study by Gu et al, data from 69 patients with AAC was compared with those from 415 patients with acute calculous cholecystitis (ACC). The investigators found that among those patients who underwent nonsurgical therapy, the posttreatment recurrence rate was just 2.7% in the AAC group, compared with 23.2% in the ACC patients.[8]

In a retrospective study of 15 nonsurgical patients who underwent endoscopic ultrasonography-guided transmural gallbladder drainage (EUS-GBD) with a lumen-apposing metal stent (LAMS) for different biliary conditions including 4 cases of acalculous cholecystitis, technical success was achieved in 14 of the 15 patients (93%), with clinical success in all 15 patients (median follow-up, 160 days).[11]


Consult with the following specialists:

  • Gastroenterologists
  • Surgeons
  • Radiologists

Dietary considerations

Patients in the acute stage of acalculous cholecystitis should receive nothing by mouth. Hydration with intravenous fluids should be provided.


Surgical Care

In surgical candidates, open or laparoscopic cholecystectomy is indicated for acute cholecystitis.[1, 12]  Laparoscopic cholecystectomy performed within 24 hours of inpatient admission has been reported to be safe and is recommended as the preferred treatment option for those with American Society of Anesthesiologists (ASA) grade I-III disease.[13]

In patients who are not surgical candidates, percutaneous cholecystostomy may be performed in the radiology suite. This procedure may the safest and most successful intervention in patients who are critically ill, have multiple comorbidities, have a high risk for conversion, or who are poor surgical candidates.[1] 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.

In an observational study (2002-2012) of 56 patients treated with percutaneous cholecystostomy for acute acalculous cholecystitis, Kirkegard et al found the procedure could be used as a definitive treatment option in 45 patients (80.4%) and as a bridge to elective laparoscopic cholecystectomy in 4 patients (7.1%) within a median of 8.8 months.[14] Six patients (10.7%) died within the 30-day postprocedure period.

Anderson et al reported that cholecystostomy offered no survival benefit for patients with severe sepsis and shock; however, cholecystostomy was associated with improved survival compared with patients without surgical management.[15]

Contributor Information and Disclosures

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, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.


Praveen K Roy, MD, AGAF Chief of Gastroenterology, Presbyterian Hospital; Medical Director of Endoscopy, Presbyterian Medical Group; Adjunct Associate Research Scientist, Lovelace Respiratory Research Institute

Praveen K Roy, MD, AGAF is a member of the following medical societies: American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

John Geibel, MD, DSc, MSc, AGAF Vice Chair and Professor, Department of Surgery, Section of Gastrointestinal Medicine, Professor, Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director of Surgical Research, Department of Surgery, Yale-New Haven Hospital; American Gastroenterological Association Fellow

John Geibel, MD, DSc, MSc, AGAF 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, Society for Surgery of the Alimentary Tract

Disclosure: Received royalty from AMGEN for consulting; Received ownership interest from Ardelyx for consulting.

Additional Contributors

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 Surgical Association, American College of Surgeons, American Gastroenterological Association, American Medical 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, Western Surgical Association

Disclosure: Nothing to disclose.


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.

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