UMEM Educational Pearls

Category: Critical Care

Title: Acalculous Cholecystitis

Posted: 11/12/2013 by Mike Winters, MD (Updated: 4/24/2024)
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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.

Rezende-Neto JB, et al. Abdominal catastrophes in the intensive care unit. Crit Care Clin 2013; 29:1017-44.