The clinical diagnosis of chronic acalculous cholecystitis

Background. Chronic acalculous cholecystitis (CAC), a diagnosis of exclusio n, appears to be more common than was previously thought. We correlated the pathology with test results and response to treatment in a prospective stu dy to obtain data for evidence-based management. Methods. The study subjects were patients with chronic biliary symptoms but had normal sonogram results. They were further investigated with esophagog astroduodenoscopy, multidiscipline evaluations, and cholecystokinin-stimula ted scintigraphy (CCK-HIDA). They, were offered laparoscopic cholecystectom y (LC) when the symptoms were intransigent, and the main abnormality was a low ejection fraction (EF) as determined by CCK-HIDA. We analyzed the histo logic findings of the gallbladder; CCK-HIDA EF, and clinical outcomes durin g the control period with a concurrent series of LC for calculus from the s ame surgeons. Results. Of 176 cholecystectomies for biliary pain without stones, 152 had pathologically verified C-AC. EF by CCK-HIDA was low in patients with CAC ( 18%) and low in normal gallbladders (26%,). In the same period, 497 patient s had cholecystectomies for cholelithiasis. Lasting symptom relief for CAC after LC zoos not different from that for calculous disease (85% vs 90%). Conclusions. The syndrome consisting of chronic biliary symptoms, stone-fiv e sonograms, low EF in CCK-HIDA, and absence of other pain sources is highl y predictive for CAC, which is well treated with LC, with results similar t o those for calculous disease.