Abstract
Purpose
Acute acalculous cholecystitis (AAC) is characterized by severe gallbladder inflammation without cystic duct obstruction. Critical illness and neurological deficits are often associated with AAC, and early radiologic imaging is necessary for the detection and timely treatment of AAC. In critically ill patients, effective surgical management is difficult. This review examines the three common surgical treatments for AAC (open cholecystectomy (OC), laparoscopic cholecystectomy (LC), or percutaneous cholecystostomy (PC)), their prevalence in current literature, and the perioperative outcomes of these different approaches using a large retrospective database.
Materials and methods
This review examined literature gathered from PubMed and Google Scholar to select more than 50 sources with data pertinent to AAC; of which 20 are described in a summary table. Outcomes from our previous research and several updated results were obtained from the University HealthSystem Consortium (UHC) database.
Results
LC has proven effective in treating AAC when the risks of general anesthesia and the chance for conversion to OC are low. In critically ill patients with multiple comorbidities, PC or OC may be the only available options. Data in the literature and an examination of outcomes within a national database indicate that for severely ill patients, PC may be safer and met with better outcomes than OC for the healthier set of AAC patients.
Conclusions
We suggest a three-pronged approach to surgical resolution of AAC. Patients that are healthy enough to tolerate LC should undergo LC early in the course of the disease. In critically ill patients, patients with multiple comorbidities, a high conversion risk, or who are poor surgical candidates, PC may be the safest and most successful intervention.
Similar content being viewed by others
References
Long TN, Heimbach DM, Carrico CJ (1978) Acalculous cholecystitis in critically III patients. Am J Surg 136:31–36. doi:10.1016/0002-9610(78)90196-4
Orlando R 3rd, Gleason E, Drezner AD (1983) Acute acalculous cholecystitis in the critically ill patient. Am J Surg 145:472–476
Gu MG, Kim TN, Song J, Nam YJ, Lee JY, Park JS (2014) Risk factors and therapeutic outcomes of acute acalculous cholecystitis. Digestion 90:75–80. doi:10.1159/000362444
Nikfarjam M, Manya K, Fink MA, Hadj AK, Muralidharan V, Starkey G et al (2012) Outcomes of patients with histologically proven acute acalculous cholecystitis. ANZ J Surg 82:918–922. doi:10.1111/j.1445-2197.2012.06202.x
Tsai YM, Yu JC, Chen CJ, Chan DC, Chang H, Lee SC et al (2011) Clinical pitfall and challenge: acute acalculous cholecystitis in a critically ill traumatic patient in the intensive care unit. J Med Sci 31:289–291
Yang HK, Hodgson WJ (1996) Laparoscopic cholecystostomy for acute acalculous cholecystitis. Surg Endosc 10:673–675
Laurila J, Syrjala H, Laurila PA, Saarnio J, Ala-Kokko TI (2004) Acute acalculous cholecystitis in critically ill patients. Acta Anaesthesiol Scand 48:986–991. doi:10.1111/j.0001-5172.2004.00426.x
Frazee RC, Nagorney DM, Mucha P Jr (1989) Acute acalculous cholecystitis. Mayo Clin Proc 64:163–167
Kalliafas S, Ziegler DW, Flancbaum L, Choban PS (1998) Acute acalculous cholecystitis: incidence, risk factors, diagnosis, and outcome. Am Surg 64:471–475
Jönsson P (1976) Postoperative acute acalculous cholecystitis. Arch Surg 111:1097. doi:10.1001/archsurg.1976.01360280055008
Liu FL, Li H, Wang XF, Shen KT, Shen ZB, Sun YH et al (2014) Acute acalculous cholecystitis immediately after gastric operation: case report and literatures review. World J Gastroenterol 20:10642–10650. doi:10.3748/wjg.v20.i30.10642
Huffman JL, Schenker S (2010) Acute acalculous cholecystitis: a review. Clin Gastroenterol Hepatol 8:15–22. doi:10.1016/j.cgh.2009.08.034
Ahmed N (2008) Acute acalculous cholecystitis complicating major trauma: a report of five cases. South Med J 101:1146–1149. doi:10.1097/SMJ.0b013e318181d587
Wang AJ, Wang TE, Lin CC, Lin SC, Shih SC (2003) Clinical predictors of severe gallbladder complications in acute acalculous cholecystitis. World J Gastroenterol 9:2821–2823
Pessaux P, Tuech JJ, Rouge C, Duplessis R, Cervi C, Arnaud JP (2000) Laparoscopic cholecystectomy in acute cholecystitis. A prospective comparative study in patients with acute vs. chronic cholecystitis. Surg Endosc 14:358–361. doi:10.1007/s004640020088
Srinivasan D, Thimmappa D, Sherigar S (2014) Gall bladder perforation in acalculous cholecystitis. Oncol Gastroenterol Hepatol Rep 3:1. doi:10.4103/2348-3113.141570
Barie PS, Eachempati SR (2010) Acute acalculous cholecystitis. Gastroenterol Clin N Am 39:343–357. doi:10.1016/j.gtc.2010.02.012, x
Karkera PJ, Sandlas G, Ranjan R, Gupta A, Kothari P (2010) Acute acalculous cholecystitis causing gall bladder perforation in children. J Indian Assoc Pediatr Surg 15:139–141. doi:10.4103/0971-9261.72439
Howard RJ (1981) Acute acalculous cholecystitis. Am J Surg 141:194–198
Anderson JE, Inui T, Talamini MA, Chang DC (2014) Cholecystostomy offers no survival benefit in patients with acute acalculous cholecystitis and severe sepsis and shock. J Surg Res 190:517–521. doi:10.1016/j.jss.2014.02.043
Herlin P, Ericsson M, Holmin T, Jonsson PE (1982) Acute acalculous cholecystitis following trauma. Br J Surg 69:475–476
Munster AM, Brown JR (1967) Acalculous cholecystitis. Am J Surg 113:730–734
Buyukasik Y, Kosar A, Demiroglu H, Altinok G, Ozcebe OI, Dundar S (1998) Acalculous acute cholecystitis in leukemia. J Clin Gastroenterol 27:146–148
Ganpathi IS, Diddapur RK, Eugene H, Karim M (2007) Acute acalculous cholecystitis: challenging the myths. HPB (Oxford) 9:131–134. doi:10.1080/13651820701315307
Savoca PE, Longo WE, Zucker KA, McMillen MM, Modlin IM (1990) The increasing prevalence of acalculous cholecystitis in outpatients. Results of a 7-year study. Ann Surg 211:433–437
Ryu JK, Ryu KH, Kim KH (2003) Clinical features of acute acalculous cholecystitis. J Clin Gastroenterol 36:166–169
Glenn F, Becker CG (1982) Acute acalculous cholecystitis. An increasing entity. Ann Surg 195:131–136
Csikesz NG, Tseng JF, Shah SA (2008) Trends in surgical management for acute cholecystitis. Surgery 144:283–289. doi:10.1016/j.surg.2008.03.033
Borzellino G, Sauerland S, Minicozzi AM, Verlato G, Di Pietrantonj C, de Manzoni G et al (2008) Laparoscopic cholecystectomy for severe acute cholecystitis. A meta-analysis of results. Surg Endosc 22:8–15. doi:10.1007/s00464-007-9511-6
Melloul E, Denys A, Demartines N, Calmes JM, Schafer M (2011) Percutaneous drainage versus emergency cholecystectomy for the treatment of acute cholecystitis in critically ill patients: does it matter? World J Surg 35:826–833. doi:10.1007/s00268-011-0985-y
Winbladh A, Gullstrand P, Svanvik J, Sandström P (2009) Systematic review of cholecystostomy as a treatment option in acute cholecystitis. HPB 11:183–193. doi:10.1111/j.1477-2574.2009.00052.x
Glenn F (1979) Acute acalculous cholecystitis. Ann Surg 189:458–465
Owen CC, Jain R (2005) Acute acalculous cholecystitis. Curr Treat Options Gastroenterol 8:99–104
Laurila J, Laurila PA, Saarnio J, Koivukangas V, Syrjala H, Ala-Kokko TI (2006) Organ system dysfunction following open cholecystectomy for acute acalculous cholecystitis in critically ill patients. Acta Anaesthesiol Scand 50:173–179
Tsakayannis DE, Kozakewich HPW, Lillehei CW (1996) Acalculous cholecystitis in children. J Pediatr Surg 31:127–131. doi:10.1016/S0022-3468(96)90334-6
Ferrarese F, Cecere V, Fabiano G (2006) Acute acalculous cholecystitis: pathophysiology and treatment. Ann Ital Chir 77:309–311
Kuster GG, Domagk D (1996) Laparoscopic cholecystostomy with delayed cholecystectomy as an alternative to conversion to open procedure. Surg Endosc 10:426–428
Bradley KM, Dempsey DT (2002) Laparoscopic tube cholecystostomy: still useful in the management of complicated acute cholecystitis. J Laparoendosc Adv Surg Tech A 12:187–191. doi:10.1089/10926420260188083
Koebrugge B, van Leuken M, Ernst MF, van Munster I, Bosscha K (2010) Percutaneous cholecystostomy in critically ill patients with a cholecystitis: a safe option. Dig Surg 27:417–421. doi:10.1159/000308460
Simorov A, Ranade A, Parcells J, Shaligram A, Shostrom V, Boilesen E et al (2013) Emergent cholecystostomy is superior to open cholecystectomy in extremely ill patients with acalculous cholecystitis: a large multicenter outcome study. Am J Surg 206:935–940. doi:10.1016/j.amjsurg.2013.08.019, discussion 940-1
Morse BC, Smith JB, Lawdahl RB, Roettger RH (2010) Management of acute cholecystitis in critically ill patients: contemporary role for cholecystostomy and subsequent cholecystectomy. Am Surg 76:708–712
Cha BH, Song HH, Kim YN, Jeon WJ, Lee SJ, Kim JD et al (2014) Percutaneous cholecystostomy is appropriate as definitive treatment for acute cholecystitis in critically ill patients: a single center, cross-sectional study. Korean J Gastroenterol 63:32–38
Granlund A, Karlson BM, Elvin A, Rasmussen I (2001) Ultrasound-guided percutaneous cholecystostomy in high-risk surgical patients. Langenbeck’s Arch Surg 386:212–217
Chung YH, Choi ER, Kim KM, Kim MJ, Lee JK, Lee KT et al (2012) Can percutaneous cholecystostomy be a definitive management for acute acalculous cholecystitis? J Clin Gastroenterol 46:216–219. doi:10.1097/MCG.0b013e3182274375
McClain T, Gilmore BT, Peetz M (1997) Laparoscopic cholecystectomy in the treatment of acalculus cholecystitis in patients after thermal injury. J Burn Care Rehabil 18:141–146
Soffer D, Blackbourne LH, Schulman CI, Goldman M, Habib F, Benjamin R et al (2007) Is there an optimal time for laparoscopic cholecystectomy in acute cholecystitis? Surg Endosc 21:805–809. doi:10.1007/s00464-006-9019-5
Soper NJ, Stockmann PT, Dunnegan DL, Ashley SW (1992) Laparoscopic cholecystectomy. The new ‘gold standard’? Arch Surg 127:917–921, discussion 921-3
Wiesen SM, Unger SW, Barkin JS, Edelman DS, Scott JS, Unger HM (1993) Laparoscopic cholecystectomy: the procedure of choice for acute cholecystitis. Am J Gastroenterol 88:334–337
Lutsevich EV, Gribkov I, Save’lev EA, Urbanovich AS (1989) Acute acalculous cholecystitis in emergency surgery. Khirurgiia (Mosk) 7:3–8
Almeida J, Sleeman D, Sosa JL, Puente I, McKenney M, Martin L (1995) Acalculous cholecystitis: the use of diagnostic laparoscopy. J Laparoendosc Surg 5:227–231
Arnot RS (1994) Laparoscopy and acalculous cholecystitis. Aust N Z J Surg 64:405–406
Dwivedi A, Shetty A, Sanghavi P, Phan T, Lakra Y, Silva Y (2004) Efficacy of laparoscopic cholecystectomy in acalculous gallbladder disease: long-term follow-up. JSLS 8:119–122
Frassinelli P, Werner M, Reed JF 3rd, Scagliotti C (1998) Laparoscopic cholecystectomy alleviates pain in patients with acalculous biliary disease. Surg Laparosc Endosc 8:30–34
Alimoglu O, Ozkan OV, Sahin M, Akcakaya A, Eryilmaz R, Bas G (2003) Timing of cholecystectomy for acute biliary pancreatitis: outcomes of cholecystectomy on first admission and after recurrent biliary pancreatitis. World J Surg 27:256–259. doi:10.1007/s00268-002-6647-3
Davis CA, Landercasper J, Gundersen LH, Lambert PJ (1999) Effective use of percutaneous cholecystostomy in high-risk surgical patients: techniques, tube management, and results. Arch Surg 134:727–731, discussion 731-2
Rattner DW, Ferguson C, Warshaw AL (1993) Factors associated with successful laparoscopic cholecystectomy for acute cholecystitis. Ann Surg 217:233–236
Peng WK, Sheikh Z, Paterson-Brown S, Nixon SJ (2005) Role of liver function tests in predicting common bile duct stones in acute calculous cholecystitis. Br J Surg 92:1241–1247. doi:10.1002/bjs.4955
Nasim S, Khan S, Alvi R, Chaudhary M (2011) Emerging indications for percutaneous cholecystostomy for the management of acute cholecystitis—a retrospective review. Int J Surg 9:456–459. doi:10.1016/j.ijsu.2011.04.008
Eggermont AM, Lameris JS, Jeekel J (1985) Ultrasound-guided percutaneous transhepatic cholecystostomy for acute acalculous cholecystitis. Arch Surg 120:1354–1356
Vauthey JN, Lerut J, Martini M, Becker C, Gertsch P, Blumgart LH (1993) Indications and limitations of percutaneous cholecystostomy for acute cholecystitis. Surg Gynecol Obstet 176:49–54
Chang YR, Ahn YJ, Jang JY, Kang MJ, Kwon W, Jung WH et al (2014) Percutaneous cholecystostomy for acute cholecystitis in patients with high comorbidity and re-evaluation of treatment efficacy. Surgery 155:615–622. doi:10.1016/j.surg.2013.12.026
Little MW, Briggs JH, Tapping CR, Bratby MJ, Anthony S, Phillips-Hughes J et al (2013) Percutaneous cholecystostomy: the radiologist’s role in treating acute cholecystitis. Clin Radiol 68:654–660. doi:10.1016/j.crad.2013.01.017
Griniatsos J, Petrou A, Pappas P, Revenas K, Karavokyros I, Michail OP et al (2008) Percutaneous cholecystostomy without interval cholecystectomy as definitive treatment of acute cholecystitis in elderly and critically ill patients. South Med J 101:586–590. doi:10.1097/SMJ.0b013e3181757b77
Berber E, Engle KL, String A, Garland AM, Chang G, Macho J et al (2000) Selective use of tube cholecystostomy with interval laparoscopic cholecystectomy in acute cholecystitis. Arch Surg 135:341–346
Ito K, Fujita N, Noda Y, Kobayashi G, Kimura K, Sugawara T et al (2004) Percutaneous cholecystostomy versus gallbladder aspiration for acute cholecystitis: a prospective randomized controlled trial. AJR Am J Roentgenol 183:193–196. doi:10.2214/ajr.183.1.1830193
Kim KH, Sung CK, Park BK, Kim WK, Oh CW, Kim KS (2000) Percutaneous gallbladder drainage for delayed laparoscopic cholecystectomy in patients with acute cholecystitis. Am J Surg 179:111–113. doi:10.1016/S0002-9610(00)00247-6
Boland GW, Lee MJ, Leung J, Mueller PR (1994) Percutaneous cholecystostomy in critically ill patients: early response and final outcome in 82 patients. AJR Am J Roentgenol 163:339–342. doi:10.2214/ajr.163.2.8037026
Shirai Y, Tsukada K, Kawaguchi H, Ohtani T, Muto T, Hatakeyama K (1993) Percutaneous transhepatic cholecystostomy for acute acalculous cholecystitis. Br J Surg 80:1440–1442
Lo LD, Vogelzang RL, Braun MA, Nemcek AA (1995) Percutaneous cholecystostomy for the diagnosis and treatment of acute calculous and acalculous cholecystitis. J Vasc Interv Radiol 6:629–634. doi:10.1016/S1051-0443(95)71150-2
Akhan O, Akinci D, Özmen MN (2002) Percutaneous cholecystostomy. Eur J Radiol 43:229–236. doi:10.1016/S0720-048X(02)00158-4
Atar E, Bachar GN, Berlin S, Neiman C, Bleich-Belenky E, Litvin S et al (2014) Percutaneous cholecystostomy in critically ill patients with acute cholecystitis: complications and late outcome. Clin Radiol 69:e247–e252. doi:10.1016/j.crad.2014.01.012
Zerem E, Omerovic S (2012) Can percutaneous cholecystostomy be a definitive management for both acute calculous and acalculous cholecystitis? J Clin Gastroenterol 46:251. doi:10.1097/MCG.0b013e3182333834
Dabus Gde C, Dertkigil SS, Baracat J (2003) Percutaneous cholecystostomy: a nonsurgical therapeutic option for acute cholecystitis in high-risk and critically ill patients. Sao Paulo Med J 121:260–262
Welschbillig-Meunier K, Pessaux P, Lebigot J, Lermite E, Aube C, Brehant O et al (2005) Percutaneous cholecystostomy for high-risk patients with acute cholecystitis. Surg Endosc 19:1256–1259. doi:10.1007/s00464-004-2248-6
Anderson JE, Chang DC, Talamini MA (2013; 2013) A nationwide examination of outcomes of percutaneous cholecystostomy compared with cholecystectomy for acute cholecystitis, 1998–2010. Surg Endosc 27:3406–3411. doi:10.1007/s00464-013-2924-5
Nguyen NT, Hinojosa M, Fayad C, Varela E, Wilson SE (2007) Use and outcomes of laparoscopic versus open gastric bypass at academic medical centers. J Am Coll Surg 205:248–255
Hinojosa MW, Murrell ZA, Konyalian VR, Mills S, Nguyen NT, Stamos MJ (2007) Comparison of laparoscopic vs open sigmoid colectomy for benign and malignant disease at academic medical centers. J Gastrointest Surg 11:1423–1429. doi:10.1007/s11605-007-0269-x, discussion 1429-30
Acknowledgments
The authors acknowledge support from the following source: The Center for Advanced Surgical Technology at the University of Nebraska Medical Center.
Authors’ contributions
Dmitry Oleynikov, MD did the study conception and design. Charles Treinen, BS and Daniel Lomelin, MPH performed the acquisition of data and did the analysis and interpretation of data. Charles Treinen, BS; Daniel Lomelin, MPH; and Crystal Krause, PhD drafted the manuscript. Charles Treinen, BS; Daniel Lomelin, MPH; Crystal Krause, PhD; and Dmitry Oleynikov, MD critically revised the manuscript.
Ethics statement
This study utilized the University HealthSystem Consortium database, which uses de-identified patient information, and as such does not require informed consent or IRB approval. The manuscript does not contain clinical studies or individual patient data.
Conflicts of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Treinen, C., Lomelin, D., Krause, C. et al. Acute acalculous cholecystitis in the critically ill: risk factors and surgical strategies. Langenbecks Arch Surg 400, 421–427 (2015). https://doi.org/10.1007/s00423-014-1267-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00423-014-1267-6