Acute acalculous cholecystitis

Acute acalculous cholecystitis is an uncommon variant of cholecystitis and accounts for about 10% of cases. Acalculous cholecystitis presents without gall stones and is usually associated with a thickened or emphysematous gallbladder wall. It is more likely to occur in patients who have critical illness, immune compromise or diabetes. Pathogens include those that commonly cause calculous cholecystitis (eg Enterobacterales and streptococci), as well as Pseudomonas aeruginosa and anaerobes.

If acalculous cholecystitis is not promptly treated, there is a high risk of gall bladder perforation and mortality. Early cholecystotomy or cholecystectomy is essential. Take blood samples for culture and susceptibility testing before starting antibiotic therapy.

See also Assessment of intra-abdominal infections.