Editing Acalculous cholecystitis (section)

== '''Management''' ==

* As per [[Acute calculous cholecystitis|calculous cholecystitis]]
* In most patients with true 'ICU' acalculous cholecystitis, start off with antibiotics, step up to perc cholecystostomy if not improving after a few days, and finally step up to cholecystectomy if still not improving
* Higher morbidity and mortality than calculous
* Percutaneous cholecystostomy is a much more attractive option - >90% of patients improve, and interval cholecystectomy is only necessary if follow-up imaging continues to demonstrate the positive findings
* GB necrosis, emphysematous cholecystitis, and perforation require cholecystectomy
* Failure to improve within 24 hours after cholecystostomy suggests gangrenous cholecystitis, catheter dislodgement, bile peritonitis, or an incorrect diagnosis. Rescue cholecystectomy is generally required to avoid imminent death.
* Remove the cholecystostomy tube when cholecystitis resolves and drainage is minimal (<10mL per day, which is usually 4-6 weeks later). Repeat the USS to exclude stones/sludge.
[[Category:Biliary]]