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At least 19 recordsLinked to original sources
PubMed1984

Low sensitivity of sonography and cholescintigraphy in acalculous cholecystitis.

Acalculous cholecystitis is difficult to diagnose by clinical means or contrast radiography. Because sonography and cholescintigraphy have both been shown to do well in the diagnosis of calculous cholecystitis, the sensitivity of these newer imaging methods was assessed retrospectively in 33 proven cases of acalculous cholecystitis. The sensitivities to acalculous cholecystitis for sonography (67%) and for cholescintigraphy (68%) were not as high as has been reported for these tests in calculous cholecystitis. Reasons for the lower sensitivity with each test and the pathogenesis of acalculous cholecystitis are discussed.

Acute Disease↗
PubMedDate not supplied

CT diagnosis of acalculous cholecystitis.

Acalculous cholecystitis is an uncommon but potentially fatal complication of prolonged critical illness. Both clinical and biochemical parameters lack sufficient sensitivity and specificity to confidently make the diagnosis preoperatively. Over a 2 year period we have evaluated 16 patients with suspected acute acalculous cholecystitis by CT. Based on CT findings, a positive diagnosis of acalculous cholecystitis was made in seven of these patients and confirmed pathologically in six. Criteria used in reaching the CT diagnosis and potential advantages of CT over other imaging modalities in this clinical context are considered.

Adolescent↗
PubMed1980

Posttraumatic acalculous cholecystitis.

Acalculous cholecystitis occurred in six patients after trauma and burns. The majority developed signs and symptoms similar to acute calculous cholecystitis. All were treated by cholecystectomy after traditional conservative treatment failed. All had either gangrenous changes or focal necrosis of the gallbladder. Postoperative recovery was uniform. Acalculous cholecystitis occurs in 0.5% of large series of injured or burned patients. Delayed recognition led to a high mortality, reported as 24% overall with 10% related to gallbladder disease. Although cholecystostomy has been advocated, it appears that cholecystectomy, when feasible, affords the best overall results.

Adult↗
PubMed1994

Laparoscopy and acalculous cholecystitis.

Acalculous cholecystitis is probably more common than the medical literature would suggest. This paper reviews a series of 13 patients who presented with symptoms of cholecystitis and who had normal ultrasound or cholecystogram examinations. Eleven patients underwent cholecystectomy and all had their symptoms ameliorated or cured. Laparoscopy is suggested as an early diagnostic procedure in these patients, followed by cholecystectomy if there is objective laparoscopic evidence of cholecystitis.

Acute Disease↗
PubMed2000

Abdominal pain in children: a case of acalculous cholecystitis.

Acalculous cholecystitis is a rare disease in children. Most cases are associated with systemic infections or with autoimmune pathologies, but it may also occur without predisposing factors. A case observed in an otherwise healthy child is reported.

Abdominal Pain↗
PubMed1984

Role of cholesterol and calcium bilirubinate crystals in acute postoperative acalculous cholecystitis.

Acute acalculous cholecystitis is rather unusual, but it is considered an increasing entity. Particularly interesting are the post-traumatic or post-operative forms of acute acalculous cholecystitis. Ischemia of the gallbladder and biliary stasis are the most likely pathogenetic factors. A case of acute acalculous cholecystitis after total gastrectomy for cancer is presented. Particular emphasis is put on the significance of cholesterol and calcium bilirubinate crystals findings in the bile of the gallbladder. The pathogenetic role of this microscopic form of lithiasis in post-operative acalculous cholecystitis is discussed. It is concluded that all surgeons should be aware of this pathology since it is becoming much more common to be faced with elderly patients having life-threatening post-operative gallbladder complications unrelated to macroscopic lithiasis.

Acute Disease↗
PubMed1990

Does visceral ischemia play a role in the pathogenesis of acute acalculous cholecystitis?

Acute acalculous cholecystitis is a virulent disease of uncertain etiology observed most commonly in critically ill patients. Although the precise mechanism is unknown, the most commonly postulated theories regarding its pathogenesis are bile stasis, sepsis, and ischemia. The role of ischemia in this process, whose etiology is multifactorial, has been difficult to elucidate. Consequently, we report two patients who developed acute acalculous cholecystitis without apparent risk for the disease other than severe visceral atherosclerosis. Both patients had symptomatic mesenteric vascular disease requiring revascularization and developed fulminant acalculous cholecystitis temporally related to exacerbation of their visceral ischemia. These cases suggest that patients with visceral atherosclerosis may be at increased risk for acute acalculous cholecystitis, perhaps due to impaired mucosal resistance when other factors, such as bile statis and sepsis, are also present.

Acute Disease↗
PubMed1984

Cholescintigraphy in acute acalculous cholecystitis.

Acute acalculous cholecystitis is a relatively rare but potentially lethal condition if not treated promptly. Since stones are not present, diagnostic procedures such as ultrasound or other radiological procedures are frequently not helpful. Tc-99m iminodiacetic acid scan results were analyzed in 11 proven cases of acute acalculous cholecystitis. All had positive tests with nonvisualization of the gallbladder giving a sensitivity of 100%. Tc-99m iminodiacetic acid cholescintigraphy is a highly reliable test and is easily performed even in acutely ill patients and should be the test of choice in all patients predisposed to and suspected of acute acalculous cholecystitis.

Acute Disease↗
PubMed1989

Acute acalculous cholecystitis.

Acute acalculous cholecystitis occurs infrequently, but the incidence seems to be increasing. Its attendant high associated morbidity and mortality dictate prompt diagnosis. Diagnosing this condition is often difficult because of the patient's debilitated medical condition and the limitations of biliary imaging techniques. During a 5-year study period (1981 through 1986), 20 patients underwent assessment and treatment for acute acalculous cholecystitis at our institution. This observation suggests an increase in incidence in comparison with a previously reported review of 28 such patients during a 16-year period at our institution. Initial treatment consisted of cholecystectomy in 18 patients, and percutaneous transhepatic cholecystostomy was successfully used in the other 2 patients. The postoperative mortality and morbidity for these 20 patients were 30% and 55%, respectively. Percutaneous transhepatic cholecystostomy should be explored further as a treatment option for acute acalculous cholecystitis.

Acute Disease↗
PubMed1984

Posttraumatic and postoperative acute acalculous cholecystitis.

Acute acalculous cholecystitis has been described following surgery unrelated to the biliary tract and after multiple trauma (DuPriest et al., 1979; Gately & Thomas, 1983; Herlin et al., 1982; Howard, 1981; Long et al., 1978; Orlando et al., 1983). Mortality rate is high, probably in part reflecting delayed diagnosis and treatment, since symptoms and signs of the primary disease often mask the symptoms of cholecystitis. Increased awareness of this rare condition might lead to more accurate diagnosis and treatment and thereby improved outcome. In this report three patients who developed acute acalculous cholecystitis following unrelated surgery or multitrauma are described.

Acute Disease↗
PubMed2005

Acute Acalculous Cholecystitis.

Acute acalculous cholecystitis is defined as acute inflammation of the gallbladder in the absence of gallstones. Patients are usually critically ill with atherosclerotic heart disease, recent trauma, burn injury, surgery, or hemodynamic instability. The presentation of acute acalculous cholecystitis may be insidious, characterized by unexplained fever, leukocytosis, hyperamylasemia, or abnormal aminotransferases, and patients often lack right upper quadrant tenderness. Diagnostic evaluation includes ultrasonography, computerized tomography, and cholescintigraphy. Given the high mortality of untreated disease, definitive treatment consists of cholecystectomy or, in poor surgical candidates, cholecystostomy. Endoscopic therapy with nasobiliary drainage and lavage is an effective treatment option in patients unable to tolerate surgery or cholecystostomy.

Journal Article↗
PubMed1992

Technical report: percutaneous cholecystostomy in acute acalculous cholecystitis.

Acute acalculous cholecystitis is a significant cause of morbidity and mortality in patients with other serious illnesses (Howard, 1981) and the mortality rate after surgical cholecystostomy may reach 15% (McGahan and Lindfors, 1989). Radiologically controlled percutaneous cholecystostomy is a safe, minimally invasive, procedure which may be curative (McGahan and Lindfors, 1989; Berger et al., 1989). Both cases described here were successfully treated by percutaneous cholecystostomy. A modified Seldinger technique was used in one and a direct 'trocar' puncture in the other. Percutaneous cholecystostomy, which is technically relatively straightforward, is now the treatment of choice for acute acalculous cholecystitis.

Acute Disease↗
PubMed2003

Gallbladder polyps, cholesterolosis, adenomyomatosis, and acute acalculous cholecystitis.

Acute acalculous cholecystitis is characterized by acute inflammation of the gallbladder in the absence of stones, usually occurring in elderly and critically ill patients with atherosclerosis, recent surgery or trauma, or hemodynamic instability. Patients may present with only unexplained fever, leukocytosis, and hyperamylasemia without right upper quadrant tenderness. If untreated, rapid progression to gangrene and perforation occurs. Surgical cholecystectomy and cholecystostomy provide the most definitive treatment although recent studies indicate success with percutaneous or endoscopic cholecystostomy. Cholesterolosis and adenomyomatosis of the gallbladder are usually clinically silent and incidental findings at the time of cholecystectomy. Cholesterolosis is characterized by mucosal villous hyperplasia with excessive accumulation of cholesterol esters within epithelial macrophages. Usually clinically silent, the condition rarely is associated with biliary symptoms or idiopathic pancreatitis and cannot reliably be detected by ultrasonography. Adenomyomatosis describes an acquired, hyperplastic lesion of the gallbladder characterized by excessive proliferation of surface epithelium with invaginations into a thickened muscularis propria. Ultrasonography may reveal a thickened gallbladder wall with intramural diverticula. Adenomyomatosis may portend a higher risk of gallbladder malignancy. Most cases of cholesterolosis and adenomyomatosis identified by imaging require no specific treatment. Gallbladder polyps include all mucosal projections into the gallbladder lumen and include cholesterol polyps, adenomyomas, inflammatory polyps, adenomas, and other miscellaneous polyps. Most polyps are nonneoplastic and rarely cause symptoms. Cholecystectomy is advocated for polyps greater than 10 mm in size because of increased risk of adenomatous or carcinomatous features.

Acalculous Cholecystitis↗
PubMed1997

Microangiopathy in acute acalculous cholecystitis.

BACKGROUND: Acute acalculous cholecystitis is a well recognized complication of many acute illnesses. Ischaemia of the gallbladder seems to have an important role in its pathogenesis. METHODS: Microangiography was performed in 15 gallbladders immediately after cholecystectomy by infusing 10 per cent barium sulphate into the specimen. Five patients had symptomatic gallstone disease, five had acute gallstone-associated cholecystitis and five had acalculous cholecystitis. Sections for histological examination were taken from adjacent sides of the microangiography section. Filling of the vessels by contrast medium was compared with histological findings. RESULTS: Microangiography of the gallbladder in acute gallstone-associated cholecystitis showed strongly dilated arterioles and regular filling of the capillary network, whereas in acalculous cholecystitis the capillary filling was poor and irregular. CONCLUSION: Disturbed microcirculation may play an important role in the pathogenesis of acute acalculous cholecystitis.

Adult↗
PubMed1996

Laparoscopic cholecystostomy for acute acalculous cholecystitis.

Acute acalculous cholecystitis (AAC) can occur in up to 18% of severely injured patients. Diagnosis is made by positive ultrasound findings of gallbladder sludge, hydrox, and wall thickening. There may also be recent-onset jaundice, positive ultrasound induced Murphy's sign, and unexplained sepsis. Mortality can be as high as 50%. Laparoscopic confirmation was obtained in six ICU trauma patients when omentum was drawn up over a distended gallbladder. Laparoscopic cholecystectomy (LC) was done by first directly decompressing the gallbladder through the fundus. This trocar was replaced by a 16 French Foley catheter passed through an Endoloop into the gallbladder and secured by tightening the loop around a cuff of gallbladder. Sepsis resolved in all cases. Only one required subsequent laparoscopic cholecystectomy. LC has a low morbidity and may be life saving during the early stages of AAC. It is not indicated in gangrene or perforation of the gallbladder.

Acute Disease↗
PubMed1985

Ultrasonographic findings in acute acalculous cholecystitis.

Acute acalculous cholecystitis (AAC) is usually seen as a complication of major surgery or trauma. Although this entity is well-known in the surgical literature, little has been written about it in the radiologic literature. A review of patient records from 1975 through 1982 revealed 16 patients with pathologically confirmed AAC on whom at least 1 sonographic study had been performed. Thickening of the gallbladder wall, a subserosal "halo" of edema, pericholecystic abscess, and marked gallbladder distention were consistent findings in AAC. In the proper clinical setting, these otherwise nonspecific findings allow a prompt and accurate diagnosis.

Acute Disease↗
PubMed1992

Acute acalculous cholecystitis.

Acute acalculous cholecystitis is now well recognised but is almost certainly not an homogeneous entity. The recognition of at least two sub-groups would appear to enhance the clinical perspective of this problem and facilitate on-going study and discussion. Two cases representing one of these sub-sets are reported, and both varieties are described.

Acute Disease↗