We undertook a retrospective study designed to ascertain the frequency
of acute acalculous cholecystitis (AAC) following open heart surgery.
In the study period 1982-1990, 22 of 6393 patients following open hea
rt surgery were recognized to have developed AAC, an incidence of 0.34
%. The majority of patients (16/22) presented within the first postope
rative week. Vague right upper quadrant physical findings, nonspecific
changes in the liver function chemistries and unexplained sepsis freq
uently led to radiologic evaluations. Ultrasonography was the most val
uable radiologic study, with a diagnosis sensitivity of 82%. Technetiu
m cholescintography can serve as a useful adjunct when interpreted in
the context of other clinical findings. Cholecystectomy was performed
in 20 patients and cholecystostomy in two. Nine (41%) patients had gan
grenous gallbladders with frank perforation in two. A specific preoper
ative diagnosis was made in 19 patients (86%). Fifteen patients surviv
ed for a mortality rate of 32%. In 12 of 15 survivors (80%), the diagn
osis of AAC was established and laparotomy performed within 48 hours o
f first clinical suspicion. Gangrene and perforation were seen in 87%
of patients in whom surgery was delayed. AAC is a life-threatening con
dition especially in critically ill patients. Experience suggests that
early diagnosis and operative intervention are the key elements of tr
eatment. Delay of operative management on the grounds of recent cardia
c surgery is not justified.