UMEM Educational Pearls

Category: Critical Care

Title: Acalculous Cholecystitis

Posted: 11/12/2013 by Mike Winters, MD (Updated: 9/27/2022)
Click here to contact Mike Winters, MD

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.