Aetiology, diagnosis and management for ischaemic cholecystitis: current perspectives

In the absence of gallstones or any other form of mechanical obstruction, hypoperfusion to the gallbladder can lead to inflammation, ischaemia and perforation. This constellation of findings has historically been simply referred to as ‘acalculous cholecystitis’. However, this term makes no distinction between inflammation due to critical illness and poor perfusion, or what we will refer to as ischaemic cholecystitis, versus other non-obstructive aetiologies. Ischaemic cholecystitis presents diagnostic as well as treatment challenges that are unique to patients in the critical care setting. More importantly, the morbidity and mortality of this proposed subcategory of acute gallbladder inflammation is much higher compared with other forms of acute cholecystitis. In the present manuscript, we introduce the concept of ischaemic cholecystitis and the importance of differentiating this clinical diagnosis from other forms of acalculous cholecystitis. Additionally, we elaborate on the most recent diagnostic modalities and treatment options specific to this vulnerable patient population.