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Acute Acalculous

Cholecystitis
Otje Hudaja, dr., SpB
Roys Pangayoman, dr. SpB

Medical Faculty Maranatha Christian


University
Dept. of Surgery Immanuel Hospital

Definition
Acute inflammatory process in
the gallbladder in the absence of
gallstones or any other form of
obstructive pathology at the
gallbladder outlet.

Etiology (Risk factors)


Multifactorial:
After severe burns
Major trauma
After surgery
As a complication of serious illness in
childhood
In association with spesific infections
(brucellosis, typhoid fever)
Acute pancreatitis

Pathogenesis

Decrease in mucosal resistance


Change in composition of bile salts
Infection in gallbladder
Hypoxia due to vascular disease
Bile stasis sludge

Diagnosis
Clinical syndrome is similar to acute
calculous cholecystitis, but usually
diagnosis is frequently delayed or more
frequently made only at surgery.
(However, all of acute acalculous
patients in Immanuel Hospital were all
diagnosed preoperatively)
Upper abdominal pain, tenderness,
palpable distended gallbladder.
USG sensitivity and specificity 50%100%.

Treatment
Semiemergency or emergency surgical
treatment (early surgery) is advocated.
Best performed with perioperative
broad spectrum antibiotic cover,
probably also include antianaerobe.
Laparotomy, establishment of diagnosis
and cholecystectomy.

Cases in Immanuel Hospital


Medical reports retrospective findings
from January 1996 until December
2000 revealed as many as 7 patients
diagnosed as acalculous cholecystitis
from among 167 cholecytitis patients,
respectively (4.19%).
Kune, GA and Gill, GD (Maingots
Abdominal Operations) stated the
incident is only 1% or less.

Statistical Results
Male: 5 patients ; Female: 2 patients
Age Oriented

Number of patients

4
3
2
1
0
0-10

10-20

21-30

31-40
Years old

41-50

51-60

> 60

Chief Complaint
1

1
Epigastic pain
Pain at RUQ
Abdominal pain

Unknow n

Pathological Findings
Acute cholecystitis
gangrenous

Acute cholecystitis

Acute cholecystitis
aspesifik
0

3
Number of Cases

Pre-surgical diagnosis

Number of cases

0
Acute
Cholelithiasis
Acute
cholecystitis
appendicitis

Gastritis

Unknown

Other Results
ALL Acute Acalculous patients were
conducting Open Cholecystectomy.
Only 2 patients were found with
perforation as complication.

Comparison Study
from other Researchers
Hottenrott, Ch., Mokler P., Paolucci, V.(1991):

Zusammenfassung:
Die akute Cholezystitis bedarf der raschen klinischen
Sicherung. Nach kurzer Optimierung des Patienten ist
die mglichst frhe Cholezystektomie anzustreben.
Diese sollte bei entsprechender Erfahrung grundsatzlich
laparoskopisch versucht werden. Erste diesbezugliche
Ergebnisse lassen eine weitere Verbesserung der
Chancen dieser Patienten aufgrund der schonenderen
Vorgehensweise erwarten.

Kolesistitis Akalkulosa Akut


Soemarko P.; Soetomo W.; Rasjid H.
FK- Unair / Surabaya
Umur

Wanita

Pria

Jumlah

11-20

22.22

21-30

22.22

31-40

33.34

41-50

11.11

51-60

11.11

Jumlah

100


Kolesistitis
akut
No.

Keluhan
nyeri

Akalkulosa

Kalkulosa

Kasus

Kasus

Test
Statistik

RUQ

100

35

100

Not
sign.

Tekan
RUQ

100

35

100

Not
sign.

Epigastrium

22.22

14.3

Not
sign.

Murphys
sign

100

35

100

Not
sign.

THanK yOu