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Acalculous Cholecystitis in the Critically Ill
- Acute acalculous cholecystitis (AAC) accounts for almost 50% of cases of acute cholecystitis in the critically ill ICU patient.
- Importantly, the mortality rate for AAC can be as high as 50%.
- Risk factors for AAC include:
- CHF
- Cardiac arrest
- DM
- ESRD on hemodialysis
- Postoperative
- Burns
- Unfortunately, the physical exam is unreliable, especially in intubated and sedated patients.
- Furthermore, less than half of patients with AAC are febrile or have a leukocytosis. LFTs can also be normal in up to 20% of patients.
- Ultrasound remains the most common imaging modality for diagnosis.
- Take Home Point: Consider AAC in the septic critically ill patient without a source.
References
Rezende-Neto JB, et al. Abdominal catastrophes in the intensive care unit. Crit Care Clin 2013; 29:1017-44.