title: The clinical diagnosis of chronic acalculous cholecystitis.
abstract: 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.
authors.affiliation: Department of Surgery, Robinson Memorial Hospital, Ravena, Ohio, USA.
authors.forename: P F
authors.initials: PF
authors.lastname: Chen
authors.forename: A
authors.initials: A
authors.lastname: Nimeri
authors.forename: Q H
authors.initials: QH
authors.lastname: Pham
authors.forename: J N
authors.initials: JN
authors.lastname: Yuh
authors.forename: J R
authors.initials: JR
authors.lastname: Gusz
authors.forename: R S
authors.initials: RS
authors.lastname: Chung
mesh_terms: 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