Title: Conservative treatment of Acalculus cholecystitis and no recurrent episode in long term follow up
Authors: Dr Jayesh Kalbhande, Dr Mayank Chaudhary
DOI: https://dx.doi.org/10.18535/jmscr/v11i5.11
Abstract
Objective: Acalculus cholecystitis is rare disease as compared to calculus cholecystitis. It is commonly seen in elderly and critically ill patients. Majority of patients with acute acalculus cholecystitis are managed with emergency surgery. On many occasions surgical management is inevitable in view of gangrene and perforation. Conservative treatment of Acute acalculus cholecystitis is a rarely practiced. Here, we discuss two cases of acute acalculus cholecystitis managed conservatively. They did not develop any recurrent episode of acalculus cholecystitis after long term follow up of more than 5 years.
Case Demonstration: (Case 1) A 64 years old male presented with fever and severe right hypochondriac pain with 2 episodes of vomiting. On clinical examination, he was vitally stable with mild tenderness in right hypochondriac region. Necessary blood investigations were done and USG abdomen and CT abdomen showed findings suggesting acute acalculus cholecystitis as the diagnosis. He was given a course of I.V. antibiotics which slowly improved his condition and was given DVT prophylaxis and now even after 7 years, he is symptom free and healthy. (Case 2) A 68 years old know diabetic male presented with sudden onset severe pain in right hypochondriac region with severe distension of abdomen, breathlessness and difficulty in talking. On clinical examination, he was conscious and oriented. P/A was grossly distended with tenderness more pronounced in right hypochondriac region. Necessary blood investigations were done and USG and CT scan revealed findings which were suggestive of acalculus cholecystitis. He was given a course of I.V. antibiotics and necessary DVT prophylaxis along with his standard antidiabetic medication and after more than 4 years he remains asymptomatic.
Conclusion: In subset of patients with acute acalculus cholecystitis who are managed conservatively, surgery can be avoided in long term as they may not develop recurrent episode.
References
- Fu Y, Pang L, Dai W, Wu S, Kong J. Advances in the study of acute acalculous cholecystitis: a comprehensive review. Digestive Diseases. 2022;40(4):468-78.
- Kullmann T, Issekutz Á, Oláh A, Rácz I. Acute acalculous cholecystitis: from common to rare causes. OrvosiHetilap. 2014 Jan 1;155(3):89-91.
- Gu MG, Kim TN, Song J, Nam YJ, Lee JY, Park JS. Risk factors and therapeutic outcomes of acute acalculous cholecystitis. Digestion. 2014;90(2):75-80.
- Bakkaloglu H, Yanar H, Guloglu R, Taviloglu K, Tunca F, Aksoy M, Ertekin C, Poyanli A. Ultrasound guided percutaneous cholecystostomy in high-risk patients for surgical intervention. World journal of gastroenterology: WJG. 2006 Nov 11;12(44):7179.
- Balmadrid B. Recent advances in management of acalculous cholecystitis. F1000Research. 2018;7.
- Ng JY, Gu J. Conservative management of acalculous cholecystitis in a seven-year-old child. Cureus. 2018 Jan 20;10(1).
- Thambidorai CR, Shyamala J, Sarala R, Vatsala RB, Tamizhisai S. Acute acalculous cholecystitis associated with enteric fever in children. The Pediatric infectious disease journal. 1995 Sep 1;14(9):812.