Acalculous cholecystitis as a risk factor for gallbladder perforation: insights from a 10-year retrospective study

Gallstones are a well-known risk factor for acute cholecystitis. A large-scale retrospective cohort study provided new insights into the relationship between gallstones and gallbladder perforation (GBP).

The study enrolled 4,497 patients who underwent cholecystectomy for acute cholecystitis at a South Korean hospital [1]. The primary goal was to evaluate gallstones as a risk factor for developing GBP. The findings were presented by Dr Se Woo Park (Hallym University Dongtan Sacred Heart Hospital, South Korea) [2].

The results showed that the incidence of GBP was significantly higher in the acalculous cholecystitis group compared with the calculous cholecystitis group (5.6% vs 1%; P<0.001). Despite similar durations of intensive care unit admissions and hospital stays between the 2 groups, the incidence of post-operative complications was significantly higher in the acalculous cholecystitis group than in the calculous cholecystitis group (2.2% vs 1%; P<0.001). The multivariable analysis confirmed that patients with acalculous cholecystitis had a higher risk of developing GBP than those with calculous cholecystitis (OR 5.0; 95% CI 2.94–8.33).

Older age (≥60 years) (OR 5.0; 95% CI 1.49–4.63), male sex (OR 2.55; 95% CI 1.48–4.57), and coexisting acute cholangitis (OR 2.84; 95% CI 1.71–4.80) were additional factors associated with the development of GBP. The incidence of GBP was significantly higher in patients who underwent delayed cholecystectomy compared with those who had early surgery (2% vs 0.9%; P<0.001).

Overall, this study suggests that acalculous cholecystitis is a risk factor for GBP, while the presence of gallstones has a relatively minor influence on GBP. “Early cholecystectomy can significantly reduce GBP morbidity and mortality. The incidence of GBP is relatively low, but its implications are very serious, warranting a high degree of suspicion, especially in higher-risk patients, such as those with acalculous cholecystitis,” concluded Dr Park.

1. 
   
   1. Lee KJ, et al. Int J Surg. 2024;110(3):1383-1391.
   2. Park SW, et al. Gallblader perforation in acute acalculous vs. calculous cholecystitis: a retrospective comparative cohort study with 10-year single-center experience. 329, DDW 2024, 18–21 May, Washington, DC, USA.

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Posted on 11 July 202411 July 2024