Ischemic cholecystitis - gangrenous, perforated and acalculous cholecystitis

The charts of 200 patients with acute inflammatory gallbladder disease were reviewed. Forty-eight patients were found with grangrenous, perforated or acalculous cholecystitis. These three conditions resulting from an ischemic gallbladder, differ from simple acute cholecystitis in its pathogenesis, laboratory findings and clinical course. Gangrenous and perforated cholecystitis accompany chronic systemic vascular compromise, whereas acalculous cholecystitis is found in a severe acute low-flow state. Awareness, together with careful clinical history, physical examination, selective blood tests and high- quality ultrasound, all contribute in the accurate diagnosis of this neglected condition. Intensive perioperative management is recommended.