Post therapeutic course of non-operative treatment for acute acalculous cholecystitis in a local community hospital

Abstract

Non-operative management (NOM) of acute acalculous cholecystitis (AAC) in patients with serious background diseases is still controversial. We evaluated the characteristics of 17 cases of NOM compared with 6 surgical cases in AAC at our hospital. The NOM group was older, and had a higher proportion of patients with Tokyo guidelines 18 (TG18) surgical risk and poor performance status (PS) than the surgical group. The TG18 severity grading was similar in both groups, and all initial treatment was successful. NOM was performed for following reasons; severe comorbidities, poor PS, advanced age, dementia, history of abdominal surgery, coexisting with incurable cancer, suspected malignancy, and mild symptoms. Two cases suffered from mild cholecystitis or cholangitis treated with another NOM. Five cases died from severe comorbidities. Elective surgery was not considered in any of the NOM cases. NOM for AAC is acceptable in poor surgical candidates and mild symptomatic patients after much discussion of the best treatment.