title: Acute acalculous cholecystitis in the critically ill: risk factors and surgical strategies.
abstract: OBJECTIVE
  Acute acalculous cholecystitis (AAC) is characterized by severe gallbladder inflammation without cystic duct obstruction. Critical illness and neurological deficits are often associated with AAC, and early radiologic imaging is necessary for the detection and timely treatment of AAC. In critically ill patients, effective surgical management is difficult. This review examines the three common surgical treatments for AAC (open cholecystectomy (OC), laparoscopic cholecystectomy (LC), or percutaneous cholecystostomy (PC)), their prevalence in current literature, and the perioperative outcomes of these different approaches using a large retrospective database.
  
  
  METHODS
  This review examined literature gathered from PubMed and Google Scholar to select more than 50 sources with data pertinent to AAC; of which 20 are described in a summary table. Outcomes from our previous research and several updated results were obtained from the University HealthSystem Consortium (UHC) database.
  
  
  RESULTS
  LC has proven effective in treating AAC when the risks of general anesthesia and the chance for conversion to OC are low. In critically ill patients with multiple comorbidities, PC or OC may be the only available options. Data in the literature and an examination of outcomes within a national database indicate that for severely ill patients, PC may be safer and met with better outcomes than OC for the healthier set of AAC patients.
  
  
  CONCLUSIONS
  We suggest a three-pronged approach to surgical resolution of AAC. Patients that are healthy enough to tolerate LC should undergo LC early in the course of the disease. In critically ill patients, patients with multiple comorbidities, a high conversion risk, or who are poor surgical candidates, PC may be the safest and most successful intervention.
authors.affiliation: Center for Advanced Surgical Technology, Department of General Surgery, University of Nebraska Medical Center, 986245 Nebraska Medical Center, Omaha, NE, 68198-6245, USA, charles.treinen@unmc.edu.
authors.forename: Charles
authors.initials: C
authors.lastname: Treinen
authors.forename: Daniel
authors.initials: D
authors.lastname: Lomelin
authors.forename: Crystal
authors.initials: C
authors.lastname: Krause
authors.forename: Matthew
authors.initials: M
authors.lastname: Goede
authors.forename: Dmitry
authors.initials: D
authors.lastname: Oleynikov
mesh_terms: D042101:Acalculous Cholecystitis / Q000453:epidemiology / Q000601:surgery*; D000208:Acute Disease; D001662:Biliary Tract Surgical Procedures; D002763:Cholecystectomy; D002767:Cholecystostomy / Q000379:methods; D015897:Comorbidity; D061887:Conversion to Open Surgery; D016638:Critical Illness; D003657:Decision Making; D006801:Humans; D010535:Laparoscopy; D012307:Risk Factors; D013812:Therapeutics