(1463) Diagnosis and Management of Acute Acalculous Cholecystitis in Patients With Sepsis

Introduction: Acute acalculous cholecystitis (AAC) is a challenging diagnosis in patients with sepsis. Ultrasonographic findings of the gallbladder are usually non-specific for diagnosis of AAC. This study aimed to evaluate the usefulness of ultrasonography to guide the diagnosis and management of AAC in patients with sepsis.

Methods: Following Institutional Review Board approval and waiver of informed consent, we retrospectively reviewed the electronic health records of all patients admitted to Gundersen Health System with a primary diagnosis of sepsis from January 1, 2010, through December 31, 2020. Those who received intravenous antibiotics and had gallbladder ultrasonography were potentially eligible for the study. Those who had no ultrasonography study during admission, whose study revealed cholelithiasis or who had undergone cholecystectomy prior to admission were excluded. We compared ultrasonographic findings and clinical features of patients who had a percutaneous cholecystostomy tube (PC) or cholecystectomy (CC) during the admission with those of patients who did not.

Results: Two-hundred sixteen patients met eligibility requirements. The study cohort was predominantly male (60%) and White (94%), with an average age at admission of 62 ± 18 years. The most common reason for ultrasonogram was an elevated concentration of liver enzymes (124/216 patients; 57%). Patients with ultrasonographic findings of gallbladder wall thickening (33%, p=0.002), presence of sludge (20%, p=0.027), gallbladder distention (8.8%, p=0.037), and positive sonographic Murphy sign (3.2%, p=0.028) were more likely to have CC or PC than those without these findings. Fifteen patients (6.9%) had sepsis caused by AAC, 12 of whom (80%) underwent CC or PC. Of the 216 patients in our study, 18 (8.3%) had a PC and 5 (2.3%) had a CC during admission. Bile specimens were cultured as routine protocol during PC, and 12 of 18 patients (67%) had bile cultures negative for growth.

Conclusions: Ultrasound study findings of the gallbladder in patients with sepsis are not specific for a diagnosis of AAC. This suggests that intravenous antibiotics could possibly be used as a sole treatment, even in patients with diagnoses of both sepsis and AAC.