recurrence of acute acalculous cholecystitis

Q: 58 years old male admitted to ICU with sepsis developed acalculous cholecystitis. Gallbladder drainage is performed via percutaneous cholecystostomy. Symptoms subsided after 4 days. Although resolved, acalculous cholecystitis has a high recurrence rate, and the drainage tube should be left for at least 8 weeks?

A) True

B) False

Answer: B

Although acalculous cholecystitis can be fatal in ICU patients if not promptly treated, the silver lining is that the recurrence rate is very low. Once symptoms subside and ultrasound confirms the resolution of inflammation with drainage and antibiotics, tube can be removed to avoid superimposed infection.

The rule of thumb is to remove the tube once the drainage is less than 10 cc per day.

#hepatology

#surgical-critical-care

References:

1. Chung YH, Choi ER, Kim KM, et al. Can percutaneous cholecystostomy be a definitive management for acute acalculous cholecystitis? J Clin Gastroenterol 2012; 46:216.

2. McLoughlin RF, Patterson EJ, Mathieson JR, et al. Radiologically guided percutaneous cholecystostomy for acute cholecystitis: long-term outcome in 50 patients. Can Assoc Radiol J 1994; 45:455.