Clinical Presentation and Risk Factors of Acalculous Cholecystitis in Outpatients, a Literature Review and Retrospective Study

Abstract

Abstract Background Acute acalculous cholecystitis in healthy patients is relatively understudied. It is usually described in patients within the intensive care unit, where it is associated with high mortality rates reaching 30%-50% in the literature. Aims To review patients who have developed AAC in outpatient or non-ICU settings, identify risk factors and clinical presentation, and compare these data with those in the literature. Methods We first performed a literature review. We then determined the inclusion criteria: acalculous cholecystitis confirmed by either an ultrasound, or CT scan, at pathology and intraoperatively. We excluded all patients hospitalized within the ICU or who developed AAC because of multiorgan failure or patients without histopathological evidence. We performed a 5-year search in our institution’s database with the terms “cholecystitis” and “acalculous cholecystitis. Results 23 patients were included in our study based on histopathology. The most frequent co-morbidities were cardiovascular and metabolic syndrome. The most common complaint was abdominal pain, ten patients (50%) presented to the emergency department with an increase of at least two of three biological markers (CRP, bilirubine and leucocytosis). We had no mortality reported at 30 days. Conclusion Epidemiologically, our population’s characteristics correspond to those of other studies, with most patients being male. The majority of patients were ASA III suggesting that this disease concerns more polymorbid patients despite a high percentage of healthy patients. Right upper quadrant pain, whether associated with leukocytosis or not, seems to be the main factor leading to further investigation. Abdominal US is considered the diagnostic technique of choice. However, most patients in our study underwent US and CT. We found that acalculous cholecystitis in outpatients, does not have the high mortality rate that was previously attributed to it, but is more frequent in polymorbid patients with cardiovascular risk factors.