Acute Acalculous Cholecystitis

Otje Hudaja, dr., SpBRoys Pangayoman, dr. SpB

Medical Faculty – Maranatha Christian University

Dept. of Surgery – Immanuel Hospital

Definition• Acute inflammatory process in

the gallbladder in the absence of gallstones or any other form of obstructive pathology at the gallbladder outlet.

Etiology (Risk factors)Multifactorial:• After severe burns• Major trauma• After surgery• As a complication of serious illness in

childhood• In association with spesific infections

(brucellosis, typhoid fever)• Acute pancreatitis

Pathogenesis• Decrease in mucosal resistance• Change in composition of bile salts• Infection in gallbladder• Hypoxia due to vascular disease• Bile stasis “sludge”

Diagnosis• Clinical syndrome is similar to acute

calculous cholecystitis, but usually diagnosis is frequently delayed or more frequently made only at surgery. (However, all of acute acalculous patients in Immanuel Hospital were all diagnosed preoperatively)

• Upper abdominal pain, tenderness, palpable distended gallbladder.

• USG sensitivity and specificity 50%-100%.

Treatment• Semiemergency or emergency surgical

treatment (early surgery) is advocated.• Best performed with perioperative broad

spectrum antibiotic cover, probably also include antianaerobe.

• Laparotomy, establishment of diagnosis and cholecystectomy.

Cases in Immanuel Hospital• Medical reports retrospective findings

from January 1996 until December 2000 revealed as many as 7 patients diagnosed as acalculous cholecystitis from among 167 cholecytitis patients, respectively (4.19%).

• Kune, GA and Gill, GD (Maingot’s Abdominal Operations) stated the incident is only 1% or less.

Statistical Results• Male: 5 patients ; Female: 2 patients

Age Oriented

0

1

2

3

4

0-10 10-20 21-30 31-40 41-50 51-60 > 60

Years old

Num

ber o

f pat

ient

s

Chief Complaint

1

1

4

1

Epigastic pain

Pain at RUQ

Abdominal pain

Unknow n

Pathological Findings

0 1 2 3 4 5 6

Acute cholecystitisaspesifik

Acute cholecystitis

Acute cholecystitisgangrenous

Number of Cases

Pre-surgical diagnosis

0

1

2

3

Acutecholecystitis

Cholelithiasis Acuteappendicitis

Gastritis Unknown

Num

ber o

f cas

es

Other Results

• ALL Acute Acalculous patients were conducting Open Cholecystectomy.

• Only 2 patients were found with perforation as complication.

Comparison Study from other Researchers

Hottenrott, Ch., Mokler P., Paolucci, V.(1991):

Zusammenfassung:Die akute Cholezystitis bedarf der raschen klinischen Sicherung. Nach kurzer Optimierung des Patienten ist die möglichst frühe Cholezystektomie anzustreben. Diese sollte bei entsprechender Erfahrung grundsatzlich laparoskopisch versucht werden. Erste diesbezugliche Ergebnisse lassen eine weitere Verbesserung der Chancen dieser Patienten aufgrund der schonenderen Vorgehensweise erwarten.

Kolesistitis Akalkulosa AkutSoemarko P.; Soetomo W.; Rasjid H.

FK- Unair / Surabaya

Umur Wanita Pria Jumlah %

11-20 1 1 2 22.22

21-30 1 1 2 22.22

31-40 2 1 3 33.34

41-50 1 - 1 11.11

51-60 - 1 1 11.11

Jumlah 5 4 9 100

…Kolesistitis

akutAkalkulosa Kalkulosa Test

Statis-tikNo. Keluhan

nyeriKasus % Kasus %

1 RUQ 9 100 35 100 Not sign.

2 Tekan RUQ

9 100 35 100 Not sign.

3 Epigas-trium

2 22.22 5 14.3 Not sign.

4 Murphy’s sign

9 100 35 100 Not sign.

THanK yOu