The clinical diagnosis of chronic acalculous cholecystitis.
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.
Chen
P F
PF
Department of Surgery, Robinson Memorial Hospital, Ravena, Ohio, USA.
Nimeri
A
A
Pham
Q H
QH
Yuh
J N
JN
Gusz
J R
JR
Chung
R S
RS
D000328:Adult; D000368:Aged; D017081:Cholecystectomy, Laparoscopic; D002764:Cholecystitis / Q000175:diagnosis*; D002908:Chronic Disease; D005260:Female; D005704:Gallbladder / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging