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Acalculous Cholecystitis

Updated on January 15, 2014

Acalculous cholecystitis is a type of gallbladder inflammation that develops without the presence of gallstones as the underlying cause. Acalculous is a term that is used to classify cholecystitis that is not related to occurrence of gallstones.

Cholecystitis is a condition characterized by gallbladder inflammation. The gallbladder is a pear-shaped, tiny organ located just below the liver, on the right side of the abdomen. It stores a digestive juice called bile which flows through into the small intestine.

Most instances of cholecystitis are caused by gallstones that obstruct the gallbladder tube. It results in accumulation of bile which then causes inflammation. Tumors and bile duct issues can also lead to cholecystitis. Acute acalculous cholecystitis usually affects people with chronic conditions like diabetes which increase the risk to gallbladder swelling and inflammation.

Treatment of acalculous cholecystitis is fully dependent on the associated symptoms and the general health of the patient. Hospitalization is required. Surgical removal of the gallbladder is the final treatment option. Untreated cases of acalculous cholecystitis can result in severe health complications such as rupture, infection, or enlargement of the organ.

Symptoms of acalculous cholecystitis

The buildup of bile associated with acalculous cholecystitis can result in a variety of signs and symptoms. A few symptoms of acalculous cholecystitis are listed below:

  • Patients will commonly experience steady pain in the upper right portion of the abdomen. This pain may occasionally migrate to the right shoulder blade and/or the back.
  • Affected individuals may also elicit severe to moderate pain in the right part of the abdomen after consuming a heavy or fatty meal. Such pain may last for many hours.
  • A few patients may experience pain in the abdomen that progressively worsens and even affects his/her ability to take deep breaths.
  • Fever, abdominal tenderness on the right side, nausea, vomiting, pain that aggravates during deep breaths, abdominal bloating, chills, and sweating are other additional symptoms of acalculous cholecystitis.
  • It is also possible that affected persons may not experience any symptoms of the condition, barring the occasional and mild discomfort in the abdomen.
  • The elderly may also only experience a tender abdominal region. Pain and fever may be absent.

Causes of acalculous cholecystitis

The collection of bile due to blockage of the gallbladder tube by tumors, gallstones, and other problems prevents the acidic liquid from being released into the small intestine and the upper digestive tract. This leads to gallbladder inflammation, cholecystitis, and acalculous cholecystitis.

Chronic cases of acalculous cholecystitis can result in abnormal physiological alterations inside the gallbladder such as tissue hardening and atrophy. The progressive shrinking and hardening of the organ leads to loss of elasticity which further affects its capability to contract and release bile. Such malfunction of the gallbladder and increased buildup of acidic bile eventually contributes to inflammation and swelling of the gallbladder.

Cholecystitis is primarily caused due to presence of gallstones which obstruct the cystic duct. Acalculouscholecystitis on the other hand is caused due to reasons other than gallstones presence. It can be caused due to a tumor that does not allow the free passage of bile from the gallbladder, as well as scarring or kinking of the bile ducts or other bile duct blockages that result in accumulation of the fluid, and eventual development of acalculous cholecystitis.

It may also be noted that women and older individuals are at greater risk to developing acalculous cholecystitis.

Treatment of acalculous cholecystitis

Individuals suffering from acalculous cholecystitis have to be hospitalized for treatment. Treatment involves the following:


  • The doctor may undertake several measures to control the symptoms of gallbladder inflammation. The symptoms usually fade away after a couple of days at the hospital.
  • If acalculous cholecystitis has resulted due to some infection or if the organ is infected, then the doctor may prescribe different antibiotics.
  • Patients may be asked to undergo fasting with prolonged periods of reduced or nil intake of drinks and food. This will decrease the workload on the swollen gallbladder. Intravenous fluids may be administered to prevent dehydration.
  • Pain killers may also be given to alleviate the gallbladder pain.


  • Once affected, acalculous cholecystitis tends to recur on a regular basis. Hence, doctors usually recommend surgical removal of the gallbladder to permanently resolve the condition. It may also be noted that patients affected by complications of acalculous cholecystitis such as rupture, perforation, or gangrene of the gallbladder may have to undergo immediate surgery.
  • The most common surgery for gallbladder removal is cholecystectomy. The surgeon will insert a tiny camera fitted at one end of a flexible tube through tiny incisions in the abdomen and then perform the surgery with the help of certain surgical tools and the images projected on the monitor by the camera.
  • The gallbladder is not an essential organ and people can continue to live a healthy life without it. The bile will directly pass onto into the digestive tract. The capability of the patient to digest food also remains unaffected. The patient may however experience a temporary case of diarrhea after the surgery.


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    • carrie Lee Night profile image

      Kept private 4 years ago from Northeast United States

      Thank you for this hub and debunking misconceptions that all gallbladder problems are due to stones :) Another word for this condition is "gallbladder attack", which can be experienced by people who already had their gallbladder taken out (strange, but true). Keep up the good work voted up and useful. Have a great weekend.