Acute acalculous cholecystitis has the highest mortality and morbidity of all benign conditions affecting the gall bladder. Patient with this condition are usually elderly and have associated cardiovascular and metabolic disease. Gangrene and perforation are more frequent than in the usual case of acute cholecystitis. Since the patients are usually associated with complicated clinical illness, the diagnoses is often difficult and the operation is often delayed. Overall incidence is increasing according to the increasing elderly patients, especially with the cardiovascular disease that is an important predisposing factor of acute acalculous cholecystitis for recent 5 years in our hospital retrospectively. Especially the biliary clonorchiasis is considered as one of the acute acalculous cholecystits in the Pusan and Gyeong Sang area of the South Korea. None of them had recent history of trauma or major surgery. Age was fifty years or older in more than 80% of patients. Male to female ration is 1.5:1.
Rights upper quadrant pain with tenderness and fever were the most common symptoms and signs. Leucosytosis was found in 80 percent of the patients. Associated cardiovascular disease including hypertension, heart diseases and diabetes were demonstrated in 12 cases of the 20 patients (60%). Ultrasonography and cholescintigraphy (DISIA or HIDA scan) were most reliable imaging techniques in the diagnosis. Forty five percent of the patients with acute acalculous cholecystitis had gangrene or perforation of the gallbladder. Diagnostic delays over 48 hours occurred in the 55 percent of the cases. And the gangrenous change was more frequent in the cases of the diagnostic delay 48 hours. In conclusion, decreased gall baldder perfusion caused by shock, congestive heart failure and arteriosclerosis probably contributed to the development of acute acalculous choecystitis. Therefore acute acalculous cholecystitis should be considered if an elderly patient with cardiovascul disease complains acute right upper quadrant pain and fever. Once the acute acalculous cholecystitis is confirmed, surgical intervention must be done as early as possible because of the rapid progression of disease. Especially, it is important to the prevention of acute acalculous cholecystitis that eradication of the clonorchis sinensis with praziquantel and avoidance of eating fresh water raw fishes.
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