Acute cholecystitis is one of the most frequent causes of acute abdominal pain in the elderly. In this chapter we review the presentation, diagnosis, and management of both calculous and acalculous cholecystitis. Acute calculous cholecystitis (ACC) results from gallbladder outlet obstruction by a gallstone and presents with acute right upper quadrant abdominal pain. Left untreated this can result in a myriad of complications including empyema, gangrene, and perforation of the gallbladder as well as other clinical entities such as gallstone ileus. Other sequelae in patients with sufficiently small gallstones include choledocholithiasis, gallstone pancreatitis, and cholangitis. While ultrasonography may confirm the diagnosis a thorough history, physical examination, and review of laboratory investigation will enable the clinician to place the patient in the spectrum of gallstone disease. Laparoscopic cholecystectomy within a few days is the current recommended management for ACC. Acute acalculous cholecystitis (AAC) is an infrequent yet potentially devastating disease typically seen in critically ill patients. AAC is associated with a very high incidence of gangrene and perforation and intensivists must maintain a high degree of clinical suspicion among patients with unexplained leukocytosis or fever. Early imaging may decrease the adverse events related to AAC. The treatment of AAC is emergent cholecystectomy.
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