Episode 101: Acalculous cholecystitis with Dennis Kim

Acute acalculous cholecystitis presents a diagnostic challenge in the ICU, particularly in patients with sepsis or prolonged NPO status. Dr. Dennis Kim emphasizes that while imaging findings like gallbladder distension and wall thickening are common, they often lack specificity in critically ill populations. A comprehensive workup includes physical examination for right upper quadrant tenderness and, when necessary, a HIDA scan to confirm cystic duct obstruction. Percutaneous cholecystostomy remains the therapeutic standard for uncomplicated cases, providing effective drainage without the risks associated with surgery in unstable patients. Conversely, operative intervention is reserved for gangrenous or perforated gallbladder disease. Early enteral feeding serves as a critical preventative measure by stimulating bile ejection and mitigating biliary stasis, significantly reducing the incidence of this condition compared to historical rates observed in patients receiving total parenteral nutrition.