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Acute cholecystitis without calculi.

Alexey Kryvenko, medical expert
Last reviewed: 05.07.2025

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Acute acalculous cholecystitis accounts for about 5-10% of all cases of acute cholecystitis in adults and 30% in children.

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Causes of acute acalculous cholecystitis

The most common predisposing factors are critical conditions such as major extrabiliary surgery, multiple trauma, extensive burns, recent childbirth, severe sepsis, mechanical ventilation, and parenteral nutrition. Severe disease associated with major injuries and bacteremia was observed during the Vietnam War.

The pathogenesis of the disease is unclear and may include many links, but the importance of such factors as bile stagnation against the background of gallbladder paresis, increased viscosity and lithogenicity, and gallbladder ischemia has been established. Emptying of the gallbladder may be impaired due to spasm of the sphincter of Oddi after the administration of opiates. In shock, a decrease in blood flow in the cystic artery is noted.

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Symptoms and diagnosis of acute acalculous cholecystitis

The symptoms of acute acalculous cholecystitis should not differ from those of acute calculous cholecystitis (fever, leukocytosis, and pain in the right upper quadrant of the abdomen), but in a seriously ill patient who is receiving mechanical ventilation and narcotic analgesics, the diagnosis is often difficult.

Blood may show elevated bilirubin and alkaline phosphatase levels, indicating cholestasis. Cholescintigraphy is less sensitive (40%) than in acute calculous cholecystitis and has a higher rate of false-positive results. Ultrasound and CT help establish the diagnosis by visualizing thickening of the gallbladder wall (more than 4 mm), perivesical fluid or subserous edema without ascites, intramural gas, and mucosal detachment. Because of the difficulties associated with diagnosing acute acalculous cholecystitis, increased vigilance is necessary, especially in patients with a high risk of developing the disease. Acute acalculous cholecystitis is more common in men, has a mortality rate twice as high as calculous cholecystitis, and is often complicated by gangrene and perforation of the gallbladder.