The clinical diagnosis of chronic acalculous cholecystitis

Surgery. 2001 Oct;130(4):578-81; discussion 581-3. doi: 10.1067/msy.2001.116906.


Background: Chronic acalculous cholecystitis (CAC), a diagnosis of exclusion, appears to be more common than was previously thought. We correlated the pathology with test results and response to treatment in a prospective study to obtain data for evidence-based management.

Methods: The study subjects were patients with chronic biliary symptoms but had normal sonogram results. They were further investigated with esophagogastroduodenoscopy, multidiscipline evaluations, and cholecystokinin-stimulated scintigraphy (CCK-HIDA). They were offered laparoscopic cholecystectomy (LC) when the symptoms were intransigent, and the main abnormality was a low ejection fraction (EF) as determined by CCK-HIDA. We analyzed the histologic findings of the gallbladder, CCK-HIDA EF, and clinical outcomes during the control period with a concurrent series of LC for calculus from the same surgeons.

Results: Of 176 cholecystectomies for biliary pain without stones, 152 had pathologically verified CAC. EF by CCK-HIDA was low in patients with CAC (18%) and low in normal gallbladders (26%). In the same period, 497 patients had cholecystectomies for cholelithiasis. Lasting symptom relief for CAC after LC was not different from that for calculous disease (85% vs 90%).

Conclusions: The syndrome consisting of chronic biliary symptoms, stone-free sonograms, low EF in CCK-HIDA, and absence of other pain sources is highly predictive for CAC, which is well treated with LC, with results similar to those for calculous disease.

MeSH terms

  • Adult
  • Aged
  • Cholecystectomy, Laparoscopic
  • Cholecystitis / diagnosis*
  • Chronic Disease
  • Female
  • Gallbladder / diagnostic imaging
  • Gallbladder / pathology
  • Gallbladder / physiopathology
  • Humans
  • Male
  • Middle Aged
  • Radionuclide Imaging