UMEM Educational Pearls


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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