What Is Acalculous Cholecystitis?

Cholecystitis means inflammation of the gallbladder. In most cases, inflammation occurs because a gallstone blocks the cystic duct. In acalculous cholecystitis, there is no gallstone causing the blockage.

Reduced blood flow to the gallbladder, bile stasis, infection, inflammation, and prolonged fasting or critical illness can contribute to the development of this condition.

Because symptoms may be less obvious in seriously ill patients, early diagnosis is important.

Causes and Risk Factors of Acalculous Cholecystitis

Acalculous cholecystitis can develop in people with serious underlying illnesses or conditions that affect normal gallbladder function.

Common risk factors include:

• Severe infections or sepsis
• Major surgery
• Prolonged hospitalization
• Critical illness or intensive care admission
• Severe trauma or burns
• Prolonged fasting
• Total parenteral nutrition
• Reduced blood supply to the gallbladder
• Certain immune-related conditions
• Severe metabolic or systemic illness

The exact cause can vary from patient to patient, so proper medical evaluation is essential.

Symptoms of Acalculous Cholecystitis

Symptoms may resemble those of other gallbladder conditions. Common symptoms include:

• Pain in the upper right side of the abdomen
• Upper abdominal tenderness
• Fever
• Nausea or vomiting
• Abdominal discomfort
• Loss of appetite
• Chills
• Increased heart rate
• Abnormal liver or inflammatory blood tests

In critically ill patients, typical abdominal pain may be absent or difficult to identify. Unexplained fever, infection, or worsening clinical condition may sometimes be the first indication of a gallbladder problem.

How Is Acalculous Cholecystitis Diagnosed?

Diagnosis generally involves a combination of medical history, physical examination, blood tests, and imaging.

1. Blood Tests

Blood investigations may show evidence of infection or inflammation. Depending on the patient, doctors may also evaluate liver function and other relevant laboratory parameters.

2. Ultrasound

Abdominal ultrasound is commonly used to evaluate the gallbladder. It may identify gallbladder wall thickening, distension, surrounding fluid, or other signs suggestive of inflammation.

3. CT Scan

A CT scan may provide additional information when ultrasound findings are unclear or when complications need to be assessed.

4. Other Imaging Tests

In selected cases, additional imaging may be recommended to confirm the diagnosis or evaluate gallbladder and biliary function.

Treatment of Acalculous Cholecystitis

Acalculous cholecystitis can progress rapidly and should not be ignored. Treatment depends on the patient’s overall condition and severity of the disease.

Treatment may include:

• Antibiotics when infection is suspected
• Intravenous fluids and supportive care
• Pain management
• Treatment of the underlying illness
• Gallbladder drainage in selected high-risk patients
• Surgery to remove the gallbladder when appropriate

For patients who are too unwell to undergo immediate surgery, percutaneous cholecystostomy, a procedure that drains the gallbladder through a catheter, may be considered in appropriate cases.

The treatment plan should always be individualized according to the patient’s clinical condition.

Can Acalculous Cholecystitis Cause Complications?

Yes. If diagnosis and treatment are delayed, severe inflammation can lead to complications such as:

• Gallbladder tissue damage
• Gangrene
• Gallbladder perforation
• Abdominal infection
• Sepsis
• Other serious systemic complications

For this reason, persistent upper abdominal pain, fever, vomiting, or unexplained deterioration in a critically ill patient should receive prompt medical attention.

When Should You See a Gastroenterologist?

Seek medical evaluation if you develop persistent upper abdominal pain, fever, vomiting, abdominal tenderness, or symptoms associated with a possible gallbladder or biliary disorder.

Patients who are already hospitalized or critically ill may require particularly careful monitoring because the symptoms of acalculous cholecystitis can be subtle.

Expert Gastroenterology Care at Indralok Gastro Liver Clinic

Dr. Upendra Gupta is a Consultant Hepato-Gastroenterologist & Therapeutic Endoscopist with qualifications including M.B.B.S., M.D. (Medicine), and D.M. (Gastroenterology), IMS-BHU.

His areas of expertise include:

• Gastrointestinal and liver diseases
• Gallbladder and biliary disorders
• Pancreatic diseases
• Inflammatory Bowel Disease (IBD)
• Gastrointestinal bleeding
• Diagnostic and therapeutic endoscopy
• ERCP
• EUS

At Indralok Gastro Liver Clinic, patients receive comprehensive evaluation and personalized management for gastrointestinal, liver, pancreatic, and biliary conditions.

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