Gallbladder Problems: When It’s Not Gallstones Acalculous gallbladder disease is really quite rare. Gallbladder problems are most often attributed to gallstones or a condition called cholecystitis — a type of gallbladder disease characterized by inflammation of the gallbladder. But cholecystitis is most often caused by gallstones — as often as 90 percent of the time. That means that fewer than 10 percent of inflamed gallbladders occur for some other reason than gallstones. And although there are other problems that can occur with the gallbladder, these two are by far the most common — acalculous gallbladder disease occurs so rarely that there aren’t readily available statistics on it. Acute acalculous gallbladder disease “typically happens in already sick patients from other causes,” says Tomasz Rogula, MD, PhD, a staff surgeon at the Bariatric and Metabolic Institute at the Cleveland Clinic in Ohio. Most often, these people are sick with a major infection called sepsis, which is a generalized infection of the whole body. The bacteria travel through the bloodstream and eventually travel to the gallbladder, infecting it and causing inflammation. By comparison, gallstones are a rather common malady, striking more than 25 million people in the United States — as much as 10 percent to 15 percent of the entire population. At the greatest risk are women ages 20 to 60, as up to 20 percent of them will have gallstones. Gallbladder Problems: Acute Acalculous Gallbladder Disease Symptoms Acute acalculous gallbladder disease, which can cause the gallbladder to become thickened and distended, is characterized by a sudden inflammation of the gallbladder wall. Symptoms include pain that:
Is localized to the right upper abdominal areaComes and goesIs accompanied by nauseaStrikes after a meal, particularly one including very fatty or greasy foods
Gallbladder Problems: Treating Acute Acalculous Gallbladder Disease If a patient complains of pain characteristic of gallbladder disease, Dr. Rogula says that an ultrasound is usually performed to check for gallstones. If they are not present, a blood test can look for bacteria in the blood that can indicate acute acalculous gallbladder disease caused by infection. The most common treatment for acute acalculous gallbladder disease, says Rogula, is intravenous administration of antibiotics — a pill won’t typically battle this raging infection. “Sometimes we need to drain the bile that is inside the gallbladder because the bile can be infected as well,” he adds. A tiny drain is inserted inside the gallbladder, which allows the bile to escape. Gallbladder removal surgery is very rarely used to treat acute acalculous gallbladder disease, Rogula says, but might be considered if antibiotics and drainage aren’t effective in treating the condition. Gallbladder Problems: If Acalculous Gallbladder Disease Goes Untreated Acute acalculous gallbladder disease isn’t something to ignore, particularly if a serious septic infection is to blame. “It can be very dangerous if not treated,” says Rogula. The condition can lead to:
Complete blockage of the bile ductsA perforation — a small hole — in the gallbladder, which allows bile to leak outside the gallbladderGangrene
If you’ve got suspicious pains in your upper right abdomen, it’s best to get it checked out — if it’s your gallbladder, gallstones are most likely to blame. But if they aren’t, your doctor will run tests to find out what’s troubling your gallbladder, and remedy the situation appropriately to ease your pain.
