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Question
70 year-old female presents from a nursing home with fever and abdominal pain. A right upper quadrant ultrasound is shown, what's the diagnosis?
Answer
Acalculous cholecystitis
Acalculous Cholecystitis
- Acalculous cholecystitis is due to gallbladder (GB) wall ischemia and GB stasis (i.e., from reduced GB contraction secondary to reduced PO intake).
- The result is gallbladder "sludge" (A), thickened GB walls (B), and pericholecystic fluid (C).
- Risk factors for acalculous cholecystitis include
- critical illness (especially sepsis)
- acute cholecystitis
- chronic immobility
- total parenteral nutrition
- diabetes and immunosuppression
- Treatment includes antibiotics covering enteric / biliary pathogens and cholecystectomy (if a surgical candidate) or percutaneous cholecystostomy if unsuitable for the OR.
- Complications include perforation, GB gangrene, and extra-biliary abscess.
References
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