Clinical Analysis of Acalculous Cholecystitis

Kim, Jong Yup; Lee, Min Koo; Kang, Yun Jung; Kim, Chang Nam; Cho, Byung Sun; Park, Joo Seung

Abstract

PURPOSE
Acalculous cholecystitis (ACC) is a rare, but potentially lethal disease, which occurs in critically ill patients and those recovering from non-biliary tract operations. Recently, an increase in the presentation of mild form ACC was noted to occur in outpatients. This study was performed to assess the clinical features and prognosis of ACC. METHODS: One thousand consecutive laparoscopic cholecystectomies, performed by a single surgeon at the Eulji Medical Center, between September, 2001 and May, 2005, were retrospectively analyzed. According to the clinical data, the preoperative findings, operative results and pathology reports, 35 patients were diagnosed with acalculous cholecystitis. RESULTS: No significant differences were found in the age and sex distributions, laboratory findings between ACC and calculous cholecystitis (CC) or incidence of associated diseases. The number of cases undergoing PTGBD, or with an inflammatory grade score during the operation, were higher for those with an ACC, but the operative times and conversion rates to open cholecystectomy were no different. Of the 35 ACC patients, only 20 had the true criteria of acute acalculous cholecystitis. However, the other 15 patients showed no strong evidence typical of acalculous cholecystitis. CONCLUSION: We experienced acalculous cholecystitis different from rare and lethal form of acalculous cholecystitis. But diagnosis of this mild form of ACC is also delayed due to lack of objective findings. High suspicious index of these diagnostic entities should be kept in mind and we should rule out other disease entities as soon as possible if ACC is questionable, so we can perform laparoscopic cholecystectomy safely on these mild forms of ACC.