Acute acalculous cholecystitis: Pathophysiology and treatment

Abstract

The absence of reliable correlation between clinical features and pathological evolution and the molteplicity of risk factors, often related to various pathophysiological pathways, make of acute acalculous cholecystitis a clinical entity well distinct from other affecting gallbladder. In spite of the slight incidence, its occurrence among serious multiple trauma patients may reach 90%. The arguability of diagnostic criteria and the missed or delayed recognition, then affecting timing of surgery are important in determining morbidity and mortality of this condition. The Authors reviewed 16 patients operated for acute acalcolous cholecystitis. US, although sometimes underestimate the severity of affection and cause false negatives, had been the first choice investigation because of its rapidity, facility of execution and repeatability. TC adds subsequent information when US images were doubtful and reveleated pericholecystic involvement more carefully. Hepatobiliary scintigraphy has high diagnostic accuracy but needs of too long execution time. Reasons of early cholecystectomy lay on clinical and experimental evidences that focal or diffuse ischemic damage of gallbladder’s wall may affect natural history of the illness and infectious overwhelming is a late event. Surgical intervention has been performed in 16 patients, must within 24 hours. Morbility has been very low, mortality scored 18.7%.