a) Mortality more than that of calculus cholecystitis
b) GB rupture chances are more
c) Immediate cholecystectomy is the treatment of choice
d) Only A & B are correct
The disease process is generally more fulminant than that of calculous cholecystitis and may progress to gangrene and perforation of the gallbladder.
Treatment of acalculous cholecystitis is similar to that of calculous cholecystitis, with cholecystectomy being therapeutic. Given the substantial inflammation and high risk of gallbladder gangrene, an open procedure is generally preferred.
However, many of these patients are critically ill and would not tolerate the physiologic insult of a laparotomy, explaining why the mortality rate of cholecystectomy for acalculous cholecystitis is up to 40%. Accordingly, percutaneous drainage of the distended and inflamed gallbladder is carried out in patients unable to tolerate a laparotomy.
Approximately 90% of patients will improve with percutaneous drainage, and the tube can eventually be removed. If follow-up imaging continues to demonstrate no stones, interval cholecystectomy is generally unnecessary.