Acute acalculous cholecystitis may develop in critically ill patients in the intensive care unit (ICU). The risk may be increased if certain risk factors are present.


Primary diagnosis:

(1) severe trauma

(2) prolonged surgery

(3) burns

(4) septicemia


Mechanisms may include:

(1) ischemia to the gallbladder wall

(2) increased bile salt concentration and/or biliary stasis


Risk factors:

(1) total parenteral nutrition (intravenous hyperalimentation)

(2) multiple transfusions

(3) severe hypotension

(4) high doses of opiates (morphine, others)

(5) dehydration

(6) prolonged fasting

(7) vascular insufficiency

(8) acute renal failure

(9) respiratory failure

(10) prolonged ventilatory support with PEEP

(11) intra-aortic balloon counterpulsation

(12) systemic vasculitis


Recent intra-abdominal surgery may contribute to a delay in diagnosis due to masking. Masking also may occur in patients treated with opiates.


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