Question

70 year-old female presents from a nursing home with fever and abdominal pain. A right upper quadrant ultrasound is shown, what's the diagnosis?

Answer

Acalculous cholecystitis

Acalculous Cholecystitis

• Acalculous cholecystitis is due to gallbladder (GB) wall ischemia and GB stasis (i.e., from reduced GB contraction secondary to reduced PO intake).
• The result is gallbladder "sludge" (A), thickened GB walls (B), and pericholecystic fluid (C).
• Risk factors for acalculous cholecystitis include
  • critical illness (especially sepsis)
  • acute cholecystitis
  • chronic immobility
  • total parenteral nutrition
  • diabetes and immunosuppression
• Treatment includes antibiotics covering enteric / biliary pathogens and cholecystectomy (if a surgical candidate) or percutaneous cholecystostomy if unsuitable for the OR.
• Complications include perforation, GB gangrene, and extra-biliary abscess.

References

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