II. Epidemiology
- Incidence: 5-10% of patients with Acute Cholecystitis
- Most common in critically ill Intensive Care patients
III. Risk factors
- Elderly
- Diabetes Mellitus
- Multiple Trauma
- Extensive Burn Injury
- Prolonged labor
- Major surgery
- Gallbladder torsion
- Systemic Vasculitis
- Biliary tract infection (Bacterial or parasitic)
IV. Findings: Symptoms and Signs
- Indistinguishable from calculous Acute Cholecystitis
- Patient ill on initial presentation
- Presentation may be subtle in already ill ICU patients
- May present as Fever Without Source
V. Imaging
-
RUQ Ultrasound or CT Abdomen
- Large, tense, static gallbladder
- No evidence of Gallstones
-
Radionuclide Cholescintography (HIDA Scan)
- Poor gallbladder filling
- Gallbladder ejection fraction <50%
VI. Management
- See Cholecystitis
VII. Prognosis
-
Intensive Care patient
- Delayed diagnosis is common, often with gall bladded gangrene or perforation at time of diagnosis
- Mortality 10-50%
- Outpatient diagnosis in an otherwise healthy patient
- Follows a typical course as those with typical Cholecystitis
VIII. References
- Aldeen and Rosenbaum (2017) 1200 Questions Emergency Medicine Boards, 3rd ed, Wolters Kluwer, Baltimore, p. 122