Acalculous Cholecystitis


  • Incidence: acalculous cholecystitis accounts for 10% of all acute cholecystitis cases (see also Acute Cholecystitis, [[Acute Cholecystitis]])
    • Acalculous Cholecystitis Occurs in 0.7-0.9% of Patients Following Open Abdominal Aortic Aneurysm Repair
    • Acalculous Cholecystitis Occurs in 0.5% of Patients Following Cardiac Surgery
    • Acalculous Cholecystitis Occurs in Up to 4% of Patients Following Bone Marrow Transplant
  • Sex: there is a male predominance (80% male) in acalculous cholecystitis cases occurring following surgery (in the absence of trauma)
  • Highest Risk Group: typically occurs in hospitalized or critically ill patients
    • However, Cases May Occur in the Outpatient Setting

Risk Factors

General Comments

  • Multiple Risk Factors are Present in Most Patients

Cardiovascular Disease

Critical Illness-Associated Disease

Gastrointestinal Disease

  • Ampullary Stenosis
  • Choledochal Cyst
  • Cystic Duct Obstruction by Bile Duct Percutaneous Transhepatic Catheter
  • Hemobilia (see Hemobilia, [[Hemobilia]])
  • Metastases to Porta Hepatis

Hematologic Disease

  • Acute Myeloid Leukemia (AML) (see Acute Myeloid Leukemia, [[Acute Myeloid Leukemia]])
  • Bone Marrow Transplant (BMT)/Stem Cell Transplant (SCT) (see Bone Marrow Transplant, [[Bone Marrow Transplant]])
    • Epidemiology: acalculous cholecystitis occurs in up to 4% of cases

Infectious Disease




  • Gallbladder Stasis and Ischemia: results in local gallbladder wall inflammation
    • Concentration of Bile Salts
    • Gallbladder Distention
    • Necrosis of Gallbladder
    • Gallbladder Perforation: occurs in severe cases

Secondary Infection with Organisms

  • General Comments: secondary infection with enteric pathogens occurs after acalculous cholecystitis is established
  • Bacteroides (see Bacteroides, [[Bacteroides]])
  • Escherichia Coli (see Escherichia Coli, [[Escherichia Coli]])
  • Enterococcus Faecalis (see Enterococcus Faecalis, [[Enterococcus Faecalis]])
  • Klebsiella (see Klebsiella, [[Klebsiella]])
  • Proteus (see Proteus, [[Proteus]])
  • Pseudomonas (see Pseudomonas, [[Pseudomonas]])


Blood Culture (see Blood Culture, [[Blood Culture]])

  • Indicated

Abdominal Ultrasound (see Abdominal-Pelvic Ultrasound, [[Abdominal-Pelvic Ultrasound]])

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Cholescintigraphy (Nuclear Medicine Hepatobiliary Imaging) (see Cholescintigraphy, [[Cholescintigraphy]])

  • Types of Cholescintigraphy Studies
    • Hepatobiliary Iminodiacetic Acid (HIDA)
    • Paraisopropyl Iminodiacetic Acid (PIPIDA)
    • Diisopropyl Iminodiacetic Acid (DISIDA)
  • Sensitivity
  • Specificity:

Clinical Manifestations

Gastrointestinal Manifestations

  • Gallbladder Perforation
    • Epidemiology: may occur in severe cases
  • RUQ Abdominal Pain (see Abdominal Pain, [[Abdominal Pain]])

Other Manifestations

  • Fever (see Fever, [[Fever]])



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