Acalculous cholecystitis - Revision history

Danbot: Add verified PubMed references (PMIDs 34657038, 20478490)

2026-03-22T10:56:59Z

Add verified PubMed references (PMIDs 34657038, 20478490)

← Older revision		Revision as of 10:56, 22 March 2026
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	<!--T:2-->		<!--T:2-->
	*Acute necroinflammatory disease of gallbladder with multifactorial pathogenesis		*Acute necroinflammatory disease of gallbladder with multifactorial pathogenesis<ref>Fu Y, et al. Advances in the Study of Acute Acalculous Cholecystitis: A Comprehensive Review. Dig Dis. 2022;40(4):468-478. PMID 34657038</ref>
	**Gallbladder stasis and ischemia leads to distension and eventually necrosis/perforation		**Gallbladder stasis and ischemia leads to distension and eventually necrosis/perforation
	**Accounts for 10% of acute cholecystitis; associated with high morbidity/mortality		**Accounts for 10% of acute cholecystitis; associated with high morbidity/mortality<ref>Barie PS, Eachempati SR. Acute acalculous cholecystitis. Gastroenterol Clin North Am. 2010 Jun;39(2):343-57, x. PMID 20478490</ref>

	</translate>		</translate>

Ostermayer: Marked this version for translation

2026-01-06T16:53:52Z

Marked this version for translation

← Older revision		Revision as of 16:53, 6 January 2026
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	<translate>		<translate>

	==Background==		==Background== <!--T:1-->

			<!--T:2-->
	*Acute necroinflammatory disease of gallbladder with multifactorial pathogenesis		*Acute necroinflammatory disease of gallbladder with multifactorial pathogenesis
	**Gallbladder stasis and ischemia leads to distension and eventually necrosis/perforation		**Gallbladder stasis and ischemia leads to distension and eventually necrosis/perforation
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	===Risk Factors===		===Risk Factors=== <!--T:3-->

			<!--T:4-->
	*[[Special:MyLanguage/Burns\|Burns]]		*[[Special:MyLanguage/Burns\|Burns]]
	*CAD		*CAD
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	==Clinical Features==		==Clinical Features== <!--T:5-->

			<!--T:6-->
	*Similar to [[Special:MyLanguage/calculous cholecystitis\|calculous cholecystitis]]		*Similar to [[Special:MyLanguage/calculous cholecystitis\|calculous cholecystitis]]
	*[[Special:MyLanguage/Jaundice\|Jaundice]] is common (20% of patients)		*[[Special:MyLanguage/Jaundice\|Jaundice]] is common (20% of patients)


	==Differential Diagnosis==		==Differential Diagnosis== <!--T:7-->

	</translate>		</translate>
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	==Evaluation==		==Evaluation== <!--T:8-->

			<!--T:9-->
	[[File:PMC3236129 wjem-12-04-12-f01.png\|thumb\|Longitudinal ultrasound of gallbladder with thickened wall and mild pericholecystic fluid (arrows). The common bile duct was normal (not shown).]]		[[File:PMC3236129 wjem-12-04-12-f01.png\|thumb\|Longitudinal ultrasound of gallbladder with thickened wall and mild pericholecystic fluid (arrows). The common bile duct was normal (not shown).]]
	[[File:PMC3649493 jscr-2012-2-4fig1.png\|thumb\|CT showing gallbladder wall thickening and pericholecystic liquid, without gallbladder lithiasis.]]		[[File:PMC3649493 jscr-2012-2-4fig1.png\|thumb\|CT showing gallbladder wall thickening and pericholecystic liquid, without gallbladder lithiasis.]]

	===Work-Up===		===Work-Up=== <!--T:10-->

			<!--T:11-->
	*CBC		*CBC
	*Chemistry		*Chemistry
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	===Diagnosis===		===Diagnosis=== <!--T:12-->

			<!--T:13-->
	*CBC		*CBC
	**Leukocytosis (70-85% of patients)		**Leukocytosis (70-85% of patients)
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	==Management==		==Management== <!--T:14-->

			<!--T:15-->
	*[[Special:MyLanguage/Antibiotics\|Antibiotics]]		*[[Special:MyLanguage/Antibiotics\|Antibiotics]]
	**[[Special:MyLanguage/Ceftriaxone\|Ceftriaxone]] + [[Special:MyLanguage/metronidazole\|metronidazole]] OR		**[[Special:MyLanguage/Ceftriaxone\|Ceftriaxone]] + [[Special:MyLanguage/metronidazole\|metronidazole]] OR
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	==Disposition==		==Disposition== <!--T:16-->

			<!--T:17-->
	*Admit		*Admit


	==See Also==		==See Also== <!--T:18-->

			<!--T:19-->
	*[[Special:MyLanguage/Gallbladder Disease (Main)\|Gallbladder Disease (Main)]]		*[[Special:MyLanguage/Gallbladder Disease (Main)\|Gallbladder Disease (Main)]]


	==References==		==References== <!--T:20-->

			<!--T:21-->
	<references/>		<references/>
	[[Category:GI]]		[[Category:GI]]
	[[Category:Surgery]]		[[Category:Surgery]]
	</translate>		</translate>

Ostermayer: Prepared the page for translation

2026-01-04T21:31:55Z

Prepared the page for translation

← Older revision		Revision as of 21:31, 4 January 2026
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			<languages/>
			<translate>

	==Background==		==Background==

	*Acute necroinflammatory disease of gallbladder with multifactorial pathogenesis		*Acute necroinflammatory disease of gallbladder with multifactorial pathogenesis
	**Gallbladder stasis and ischemia leads to distension and eventually necrosis/perforation		**Gallbladder stasis and ischemia leads to distension and eventually necrosis/perforation
	**Accounts for 10% of acute cholecystitis; associated with high morbidity/mortality		**Accounts for 10% of acute cholecystitis; associated with high morbidity/mortality

			</translate>
	{{Gallbladder background}}		{{Gallbladder background}}
			<translate>
			</translate>
	{{Gallbladder disease types}}		{{Gallbladder disease types}}
			<translate>


	===Risk Factors===		===Risk Factors===
	*[[Burns]]
			*[[Special:MyLanguage/Burns\|Burns]]
	*CAD		*CAD
	*[[DM]]		*[[Special:MyLanguage/DM\|DM]]
	*Immunosuppression		*Immunosuppression
	*[[Infection]]		*[[Special:MyLanguage/Infection\|Infection]]
	*[[Mechanical ventilation]]		*[[Special:MyLanguage/Mechanical ventilation\|Mechanical ventilation]]
	*Medications (eg, [[opioids]], sunitinib)		*Medications (eg, [[Special:MyLanguage/opioids\|opioids]], sunitinib)
	*Multiple [[transfusions]]		*Multiple [[Special:MyLanguage/transfusions\|transfusions]]
	*Nonbiliary surgery		*Nonbiliary surgery
	*[[Sepsis]]/[[hypotension]]		*[[Special:MyLanguage/Sepsis\|Sepsis]]/[[Special:MyLanguage/hypotension\|hypotension]]
	*[[Vasculitis]]		*[[Special:MyLanguage/Vasculitis\|Vasculitis]]
	*TPN, especially TPN > 3 mo		*TPN, especially TPN > 3 mo


	==Clinical Features==		==Clinical Features==
	*Similar to [[calculous cholecystitis]]
	*[[Jaundice]] is common (20% of patients)		*Similar to [[Special:MyLanguage/calculous cholecystitis\|calculous cholecystitis]]
			*[[Special:MyLanguage/Jaundice\|Jaundice]] is common (20% of patients)


	==Differential Diagnosis==		==Differential Diagnosis==

			</translate>
	{{DDX RUQ}}		{{DDX RUQ}}
			<translate>


	==Evaluation==		==Evaluation==

	[[File:PMC3236129 wjem-12-04-12-f01.png\|thumb\|Longitudinal ultrasound of gallbladder with thickened wall and mild pericholecystic fluid (arrows). The common bile duct was normal (not shown).]]		[[File:PMC3236129 wjem-12-04-12-f01.png\|thumb\|Longitudinal ultrasound of gallbladder with thickened wall and mild pericholecystic fluid (arrows). The common bile duct was normal (not shown).]]
	[[File:PMC3649493 jscr-2012-2-4fig1.png\|thumb\|CT showing gallbladder wall thickening and pericholecystic liquid, without gallbladder lithiasis.]]		[[File:PMC3649493 jscr-2012-2-4fig1.png\|thumb\|CT showing gallbladder wall thickening and pericholecystic liquid, without gallbladder lithiasis.]]

	===Work-Up===		===Work-Up===

	*CBC		*CBC
	*Chemistry		*Chemistry
	*[[LFTs]]		*[[Special:MyLanguage/LFTs\|LFTs]]
	*Blood cultures		*Blood cultures
	*[[RUQ Ultrasound]]		*[[Special:MyLanguage/RUQ Ultrasound\|RUQ Ultrasound]]


	===Diagnosis===		===Diagnosis===

	*CBC		*CBC
	**Leukocytosis (70-85% of patients)		**Leukocytosis (70-85% of patients)
	*[[LFTs]]		*[[Special:MyLanguage/LFTs\|LFTs]]
	**[[Hyperbilirubinemia]]		**[[Special:MyLanguage/Hyperbilirubinemia\|Hyperbilirubinemia]]
	**Mildly elevated alkaline phosphatase		**Mildly elevated alkaline phosphatase
	**Transaminitis		**Transaminitis
	*[[RUQ Ultrasound]]		*[[Special:MyLanguage/RUQ Ultrasound\|RUQ Ultrasound]]
	**Absence of gallstones or sludge		**Absence of gallstones or sludge
	**Thickened wall (>5 mm) with pericholecystic fluid		**Thickened wall (>5 mm) with pericholecystic fluid
	**Positive sonographic Murphy's sign		**Positive sonographic Murphy's sign
	**Emphysematous cholecystitis with gas bubbles arising in fundus of gallbladder		**Emphysematous cholecystitis with gas bubbles arising in fundus of gallbladder
	**Frank perforation of gallbladder with associated [[abscess]] formation		**Frank perforation of gallbladder with associated [[Special:MyLanguage/abscess\|abscess]] formation


	==Management==		==Management==
	*[[Antibiotics]]
	**[[Ceftriaxone]] + [[metronidazole]] OR		*[[Special:MyLanguage/Antibiotics\|Antibiotics]]
	**[[Piperacillin/tazobactam]]		**[[Special:MyLanguage/Ceftriaxone\|Ceftriaxone]] + [[Special:MyLanguage/metronidazole\|metronidazole]] OR
			**[[Special:MyLanguage/Piperacillin/tazobactam\|Piperacillin/tazobactam]]
	*Cholecystectomy		*Cholecystectomy
	**Definitive therapy		**Definitive therapy


	==Disposition==		==Disposition==

	*Admit		*Admit


	==See Also==		==See Also==
	*[[Gallbladder Disease (Main)]]
			*[[Special:MyLanguage/Gallbladder Disease (Main)\|Gallbladder Disease (Main)]]


	==References==		==References==

	<references/>		<references/>
	[[Category:GI]]		[[Category:GI]]
	[[Category:Surgery]]		[[Category:Surgery]]
			</translate>

Masoodrm: /* Evaluation */

2022-04-30T15:31:09Z

Evaluation

← Older revision		Revision as of 15:31, 30 April 2022
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	*[[LFTs]]		*[[LFTs]]
	**[[Hyperbilirubinemia]]		**[[Hyperbilirubinemia]]
	**~~Alk phos elevation (mild)~~		**Mildly elevated alkaline phosphatase
	**Transaminitis		**Transaminitis
	*[[RUQ Ultrasound]]		*[[RUQ Ultrasound]]

Rossdonaldson1: /* Evaluation */

2020-05-02T13:02:09Z

Evaluation

← Older revision		Revision as of 13:02, 2 May 2020
Line 29:		Line 29:

	==Evaluation==		==Evaluation==
	[[File:PMC3236129 wjem-12-04-12-f01.png\|thumb\|Longitudinal ultrasound of gallbladder with thickened wall ~~(calipers)~~ and mild pericholecystic fluid (arrows). The common bile duct was normal (not shown).]]		[[File:PMC3236129 wjem-12-04-12-f01.png\|thumb\|Longitudinal ultrasound of gallbladder with thickened wall and mild pericholecystic fluid (arrows). The common bile duct was normal (not shown).]]
	[[File:PMC3649493 jscr-2012-2-4fig1.png\|thumb\|CT showing gallbladder wall thickening and pericholecystic liquid, without gallbladder lithiasis.]]		[[File:PMC3649493 jscr-2012-2-4fig1.png\|thumb\|CT showing gallbladder wall thickening and pericholecystic liquid, without gallbladder lithiasis.]]
	===Work-Up===		===Work-Up===

Rossdonaldson1: /* Evaluation */

2020-05-02T13:01:38Z

Evaluation

← Older revision		Revision as of 13:01, 2 May 2020
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	==Evaluation==		==Evaluation==
	[[File:PMC3236129 wjem-12-04-12-f01.png\|thumb\|Longitudinal ~~view~~ of gallbladder with thickened ~~anterior~~ wall calipers ~~with~~ mild pericholecystic fluid (arrows). The common bile duct was ~~measured to be 4 mm in diameter~~.]]		[[File:PMC3236129 wjem-12-04-12-f01.png\|thumb\|Longitudinal ultrasound of gallbladder with thickened wall (calipers) and mild pericholecystic fluid (arrows). The common bile duct was normal (not shown).]]
	[[File:PMC3649493 jscr-2012-2-4fig1.png\|thumb\|CT showing gallbladder wall thickening and pericholecystic liquid, without gallbladder lithiasis.]]		[[File:PMC3649493 jscr-2012-2-4fig1.png\|thumb\|CT showing gallbladder wall thickening and pericholecystic liquid, without gallbladder lithiasis.]]
	===Work-Up===		===Work-Up===

Rossdonaldson1: /* Evaluation */

2020-05-02T13:00:36Z

Evaluation

← Older revision		Revision as of 13:00, 2 May 2020
Line 29:		Line 29:

	==Evaluation==		==Evaluation==
			[[File:PMC3236129 wjem-12-04-12-f01.png\|thumb\|Longitudinal view of gallbladder with thickened anterior wall calipers with mild pericholecystic fluid (arrows). The common bile duct was measured to be 4 mm in diameter.]]
	[[File:PMC3649493 jscr-2012-2-4fig1.png\|thumb\|CT showing gallbladder wall thickening and pericholecystic liquid, without gallbladder lithiasis.]]		[[File:PMC3649493 jscr-2012-2-4fig1.png\|thumb\|CT showing gallbladder wall thickening and pericholecystic liquid, without gallbladder lithiasis.]]
	===Work-Up===		===Work-Up===

Rossdonaldson1: /* Evaluation */

2020-05-02T12:57:34Z

Evaluation

← Older revision		Revision as of 12:57, 2 May 2020
Line 31:		Line 31:
	[[File:PMC3649493 jscr-2012-2-4fig1.png\|thumb\|CT showing gallbladder wall thickening and pericholecystic liquid, without gallbladder lithiasis.]]		[[File:PMC3649493 jscr-2012-2-4fig1.png\|thumb\|CT showing gallbladder wall thickening and pericholecystic liquid, without gallbladder lithiasis.]]
	===Work-Up===		===Work-Up===
			*CBC
			*Chemistry
			*[[LFTs]]
			*Blood cultures
			*[[RUQ Ultrasound]]

			===Diagnosis===
	*CBC		*CBC
	**Leukocytosis (70-85% of patients)		**Leukocytosis (70-85% of patients)
	*Chemistry
	*[[LFTs]]		*[[LFTs]]
	**[[Hyperbilirubinemia]]		**[[Hyperbilirubinemia]]
	**Alk phos elevation (mild)		**Alk phos elevation (mild)
	**Transaminitis		**Transaminitis
	*Blood cultures
	*[[RUQ Ultrasound]]		*[[RUQ Ultrasound]]
	**Absence of gallstones or sludge		**Absence of gallstones or sludge

Rossdonaldson1: /* Evaluation */

2020-05-02T12:56:31Z

Evaluation

← Older revision		Revision as of 12:56, 2 May 2020
Line 29:		Line 29:

	==Evaluation==		==Evaluation==
			[[File:PMC3649493 jscr-2012-2-4fig1.png\|thumb\|CT showing gallbladder wall thickening and pericholecystic liquid, without gallbladder lithiasis.]]
	===Work-Up===		===Work-Up===
	*CBC		*CBC

Rossdonaldson1: /* Management */

2020-05-02T12:47:51Z

Management

← Older revision		Revision as of 12:47, 2 May 2020
Line 46:		Line 46:

	==Management==		==Management==
	*Antibiotics		*[[Antibiotics]]
	**[[Ceftriaxone]] + [[metronidazole]] OR		**[[Ceftriaxone]] + [[metronidazole]] OR
	**[[Piperacillin/tazobactam]]		**[[Piperacillin/tazobactam]]