ACUTE ACALCULOUS CHOLECYSTITIS IN THE CRITICALLY ILL

Acute acalculous cholecystitis, inflammation of the gall-bladder witho ut evidence of calculi, accounts for 2 to 15% of all cases of acute ch olecystitis.5,11,16,18,27 The incidence of acute acalculous cholecysti tis in adults undergoing cholecystectomy may be as high as 15 per cent and up to 32 per cent in the pediatric population.6,13 During the pas t 10 years, 22 patients who were being treated in the intensive care u nit for other reasons underwent cholecystectomy for acute acalculous c holecystitis. Eighteen (82%) of the patients were male, the average ag e was 61 years, and patients spent an average of 19 days in the intens ive care unit prior to cholecystectomy. The most common clinical findi ngs were right upper quadrant tenderness and pain. Fifteen (68%) of th e patients had a previous operative procedure. HIDA scans were positiv e in all 12 patients in which they were performed. Ultrasounds were po sitive in 13 of 17 (76%) patients, and CT scans 7 of 9 (78%). Nine (41 %) patients died. Early diagnosis with rapid intervention is crucial i n managing this disease if outcome is to be improved. Gangrene and/or necrosis of the gallbladder was present in 13 (59%) of patients, sugge sting that cholecystectomy may be the best approach to management.