Mo1143 Risk Factors and Therapeutic Outcomes of Acute Acalculous Cholecystitis

Abstract

Background and aims: Acute acalculous cholecystitis (AAC) is traditionally known to occur in critically ill patients and to have a worse prognosis compared to acute calculous cholecystitis (ACC). Although cholecystectomy is usually recommended for the treatment of AAC, non-surgical treatment may be a good alternative treatment especially in high risk patients. The objective of this study was to review the incidence, risk factors, treatment modality and therapeutic outcome of AAC. Methods: The data of 69 AAC patients and 415 ACC patients between January 2007 and August 2011 were collected from hospital records. The diagnostic criteria for acute cholecystitis were right upper quadrant abdominal pain or tenderness with characteristic image findings compatible to acute cholecystitis. AAC was defined when there were no stones or sludge in the biliary tree on imaging study. The demographic characteristics, clinicopathologic features, and therapeutic modality and outcomes were analyzed and compared between AAC and ACC patients. Results: sixty-nine cases of the total 484 patients with acute cholecystitis fulfilled the criteria for the diagnosis of AAC. Age was not significantly different between AAC and ACC group (67 vs. 63 years). There was male predominance in the AAC group compared to ACC group. Cerebrovascular accidents were significantly more frequent in patients with AAC than those with ACC (15.9% vs. 6.7%, p<0.05, OR 2.621, 95% CI, 1.238-5.550). There was higher incidence of gangrenous cholecystitis in AAC group than ACC group (31.2% vs. 5.6%, p=0.000, OR 7.647, 95% CI, 3.130-18.685). Of the 69 AAC patients, 32 patients (46.4%) underwent cholecystectomy, 12 patients (17.4%) were treated with percutaneous cholecystostomy, and 25 patients (36.2%) received antibiotics only. The overall therapeutic outcomes of AAC were not statistically different from patients with ACC. Conclusions: The risk of AAC increases in patients with advanced age and cerebrovascular accidents. Cholecystectomy is recommended because of higher incidence of gangrenous cholecystitis in AAC patients. However, non-surgical treatment such as percutaneous cholecystostomy or antibiotics only might be effective especially in high risk patients.