Histopathology of acute acalculous cholecystitis in critically ill patients.
OBJECTIVE
To illustrate the histopathological features of acute acalculous cholecystitis (AAC) of critically ill patients and to compare them with those of acute calculous cholecystitis (ACC) and normal gallbladders.


RESULTS
We studied 34 gallbladders with AAC and compared them with 28 cases of ACC and 14 normal gallbladders. Histological features were systematically evaluated. Typical features in AAC were bile infiltration, leucocyte margination of blood vessels and lymphatic dilation. Bile infiltration in the gallbladder wall was more common and extended wider and deeper into the muscle layer in AAC compared with ACC. Epithelial degeneration and defects and widespread occurrence of inflammatory cells were typical features in ACC. Necrosis in the muscle layer was also more common and extended wider and deeper in ACC. There were no differences in the occurrence of capillary thromboses, lymphatic follicles or Rokitansky-Aschoff sinuses between the AAC and ACC samples.


CONCLUSIONS
There are characteristic differences in histopathology between AAC and ACC, although due to overlap, none appeared to be specific as such for either condition. These results suggest that AAC is largely a manifestation of systemic critical illness, whereas ACC is a local disease of the gallbladder.
Laurila
J J
JJ
Department of Anaesthesiology, Division of Intensiv Care, Oulu University Hospital, Finland. jouko.laurila@pp.fimnet.fi
Ala-Kokko
T I
TI
Laurila
P A
PA
Saarnio
J
J
Koivukangas
V
V
Syrjälä
H
H
Karttunen
T J
TJ
D042101:Acalculous Cholecystitis / Q000473:pathology*; D000208:Acute Disease; D000273:Adipose Tissue / Q000473:pathology; D001646:Bile / Q000502:physiology; D002196:Capillaries / Q000473:pathology; D041881:Cholecystitis, Acute / Q000473:pathology; D016638:Critical Illness; D004847:Epithelial Cells / Q000473:pathology; D005260:Female; D005704:Gallbladder / Q000098:blood supply / Q000473:pathology; D006801:Humans; D042601:Lymphatic Vessels / Q000473:pathology; D008221:Lymphoid Tissue / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009130:Muscle, Smooth / Q000473:pathology