ACALCULUS CHOLECYSTITIS

      This is an uncommon condition in which there will be gall bladder infection in the absence of gall stones. Although the exact pathophysiology is poorly understood, concentration of biliary solutes and stasis in the gall bladder clearly play important roles. Risk factors for the development of acalculous cholecystitis include older age, critical illness, burns, trauma, and prolonged usage of total parenteral nutrition, diabetes and immunosuppression. The disease process is more fulminant than the calculus cholecystitis and may progress to gangrene and perforation.

      The presentation is with upper abdominal pain more towards ride side, fever and loss of appetite. The diagnosis is done with ultrasonography of abdomen and will be confirmed with computerized tomography of abdomen with intravenous contrast.

      The treatment of this condition is surgical by removing the gall bladder by laparoscopy technique or by open surgical technique. Most often this acalculous cholecystitis occurs in critically ill patients. If the patient is fit for laparoscopic procedure, then laparoscopic gall bladder removal is done. Otherwise, open gall bladder removal can be proceeded. The outcome of the surgical procedure depends on the nature of coexisting disease. If the general condition of the patient is very poor then percutaneous drainage of gall bladder is an option to improve the general condition of the patient and definitive treatment will be decided later depending on the recovery of the patient.