Acalculous Cholecystitis in the Critically Ill

• Acute acalculous cholecystitis (AAC) accounts for almost 50% of cases of acute cholecystitis in the critically ill ICU patient.
• Importantly, the mortality rate for AAC can be as high as 50%.
• Risk factors for AAC include:
  • CHF
  • Cardiac arrest
  • DM
  • ESRD on hemodialysis
  • Postoperative
  • Burns
• Unfortunately, the physical exam is unreliable, especially in intubated and sedated patients.
• Furthermore, less than half of patients with AAC are febrile or have a leukocytosis.  LFTs can also be normal in up to 20% of patients.
• Ultrasound remains the most common imaging modality for diagnosis.
• Take Home Point: Consider AAC in the septic critically ill patient without a source.

References

Rezende-Neto JB, et al. Abdominal catastrophes in the intensive care unit. Crit Care Clin 2013; 29:1017-44.