Acalculous Cholecystitis Treatment & Management
- Author: Homayoun Shojamanesh, MD; Chief Editor: John Geibel, MD, DSc, MA more...
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.[7] 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.
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