UMEM Educational Pearls

Title: What's the Diagnosis?

Posted: 4/27/2015 by Haney Mallemat, MD
Click here to contact Haney Mallemat, MD

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?

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.

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