Clinical diagnosis of acute cholecystitis may be difficult when findings are atypical. The differential diagnosis includes cholangitis, pancreatitis, appendicitis, peptic ulcer, and pleurisy. Treatment Management includes rehydration with IV fluids and electrolytes. No oral feedings are given, and nasogastric suction is instituted. Parenteral antibiotics are usually initiated when the diagnosis is suspected.
Cholecystectomy cures acute cholecystitis and biliary colic in nearly all patients.
When the diagnosis is clear and the patient is at standard surgical risk, operation may be scheduled as an early but elective procedure during the 1st or 2nd day of the illness. Increasing abdominal pain, leukocytosis, or fever may indicate empyema, gangrene, or perforation and requires urgent surgical management. In patients at very high surgical risk, percutaneous cholecystostomy may be an alternative. Prolonged use of TPN predisposes patients to bile stasis and is another cause of this disorder. A high index of suspicion is necessary to diagnose acute acalculous cholecystitis in critically ill patients with sepsis.