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Acalculous Cholecystitis

Last reviewed by Dr. Raj MD on January 12th, 2022.

Acalculous Cholecystitis Definition

Acalculous cholecystitis is a rare condition that commonly affects injured patient and critically ill patient. The disease is characterized by an inflammation of the gallbladder without the presence of gallstones.

Acalculous cholecystitis is a necroinflammatory disease that often develops as a complication of various medical conditions. It is a type of cholecystitis without gallstone as the underlying cause. The condition is predominant among the male gender without racial predilection. It mostly affects people between the ages of 40 to 80 years although the disease can affect people from all age levels. The mortality rate for acalculous cholecystitis is high particularly in patient suffering from sepsis and those who are critically ill.

Acute cholecystitis is a condition that involves the gallbladder. The gallbladder is a small organ that is located below the liver and on the posterior right of the abdomen. It is a pear shaped organ that serves as bile storage when the bile is not instantly used for digestion.

Acalculous cholecystitis is a form of cholecystitis where cholecystitis is defined as the inflammation of the gallbladder as a result of gallstones or cholelithiasis that obstructs the cystic duct. The obstruction of the cystic duct results to the collection of the bile within the gallbladder and increase pressure in the gallbladder as well leading to its inflammation. Acalculous cholecystitis on the other hand is the inflammation of the gallbladder without the incidence or the presence of a gallstone that can obstruct the cystic duct.

Acalculous Cholecystitis Symptoms

Acalculous cholecystitis is a gallbladder inflammation without the formation of gallstone. It is a disease that generally affects critically ill patient and injured patient who are confined in the hospital although outpatient setting is also potential for Acalculous cholecystitis. Most patients suffering from Acalculous cholecystitis would not recognize the symptoms of the disease while most patients also are critically ill that symptoms are seldom communicated or reported.

Various signs and symptoms can result with Acalculous cholecystitis and is often the result of the accumulation of the bile within the gallbladder. Onset of fever and pain on the right upper quadrant of the abdomen are the clinical features of Acalculous cholecystitis.

Signs and symptoms of the disease on the other hand may include the following:

  • A consistent pain on the right upper quadrant of the abdomen which may radiate to the back or on the right shoulder blade
  • Some patient may experience a progressive pain that often worsens which can result to the inability of the patient to take deep breaths
  • A lingering pain that can last for several hours with a degree from mild to severe and is usually felt on the right upper quadrant of the abdomen especially after eating large amount of food
  • An occasional mild discomfort in the abdomen
  • Onset of fever and chills
  • Nausea and vomiting
  • Inability to breathe deeply due to pain
  • Abdominal tenderness particularly on the right side of the abdomen
  • Unusual sweating
  • Bloating of the abdomen

In elderly patients, the symptoms of pain and fever may not be experienced although they may exhibit symptoms of pain and tenderness in the abdominal region. The onset of acalculous cholecystitis is rather sudden that half the majority of patients have presented medical complications from the cholecystitis by the time diagnosis is completed. The prevalence of the disease among critically ill or debilitated patients including the rapid onset of medical complications has made the disease high in mortality rate despite the fact that it is a rare medical condition.

The signs and symptoms involving the right upper quadrant are initially lacking for almost majority of the patient. The sudden and unexplainable onset of fever in gravely ill patients whether in hospital setting or outside hospital setting may be the only clue of an existing acalculous cholecystitis.


Acalculous cholecystitis occurs when there is an existing inflammation of the gallbladder that resulted from the obstruction of the bile. It occurs without the presence of gallstones and the obstruction is due to other existing condition that disrupted the normal passage of bile from the gallbladder.

Critically ill patients exposed to prolonged immobility, hemodynamic instability and prolonged fasting is potential for acalculous cholecystitis. A healthy gallbladder generally empties the bile and is replenished with less toxic bile. The gallbladder on the other hand needs to be stimulated and requires high metabolic energy to function properly. The course of prolonged fasting and immobility among critically ill patients deprived them of the necessary stimulation and high metabolic energy thus exposing the gallbladder epithelium from the concentrated bile that has accumulated within the gallbladder leading to the inflammation of the gallbladder.


The goal of treatment in patient with acalculous cholecystitis is the prevention of rapid progression deterioration and perforation of the gallbladder that treatment is necessary immediately after the diagnosis is completed.

Medical care of acalculous cholecystitis involves several measures to control the signs and symptoms. The aim of medical intervention is to reduce the swelling or inflammation of the gallbladder and to alleviate the pain. The method of treatment on the other hand depends on the cause of acalculous cholecystitis.

Open cholecystectomy or laparoscopic cholecystectomy are the two surgical interventions indicated for patients who are candidates for surgical procedure. Surgical intervention is particularly indicated for patients already with complications of acalculous cholecystitis and high risk for gallbladder perforation or ruptures or if gangrene of the gallbladder is already present.

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