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World J Clin Cases. Aug 16, 2021; 9(23): 6674-6685
Published online Aug 16, 2021. doi: 10.12998/wjcc.v9.i23.6674
Acute acalculous cholecystitis due to infectious causes
Ioulia Markaki, Afroditi Konsoula, Lamprini Markaki, Nikolaos Spernovasilis, Marios Papadakis
Ioulia Markaki, Department of Emergency, General Hospital of Kythira “Trifyllio”, Kythira 80200, Greece
Afroditi Konsoula, Department of Emergency, General Hospital of Mytilene "Vostaneio", Lesvos 81132, Greece
Lamprini Markaki, Department of Pediatrics, "Agia Sofia" Children's Hospital, Athens 11527, Greece
Nikolaos Spernovasilis, School of Medicine, University of Crete, Heraklion 71003, Greece
Marios Papadakis, Department of Surgery II, University of Witten-Herdecke, Wuppertal 40235, NRW, Germany
Author contributions: Spernovasilis N and Papadakis M put forward the learning concept; Markaki I, Konsoula A, Spernovasilis N and Papadakis M designed the manuscript; Markaki I, Konsoula A and Markaki L did the literature search and drafted the manuscript; all authors reviewed and approved the final draft of the manuscript.
Conflict-of-interest statement: The authors declare no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Marios Papadakis, MD, MSc, PhD, Research Scientist, Surgeon, Department of Surgery II, University of Witten-Herdecke, 40 Heusnerstrasse, Wuppertal 40235, NRW, Germany. marios_papadakis@yahoo.gr
Received: March 28, 2021
Peer-review started: March 28, 2021
First decision: April 28, 2021
Revised: May 8, 2021
Accepted: July 5, 2021
Article in press: July 5, 2021
Published online: August 16, 2021
Processing time: 130 Days and 5.4 Hours
Abstract

Acute acalculous cholecystitis (AAC) is an inflammation of the gallbladder not associated with the presence of gallstones. It usually occurs in critically ill patients but it has also been implicated as a cause of cholecystitis in previously healthy individuals. In this subgroup of patients, infectious causes comprise the primary etiology. We, herein, discuss the pathophysiological mechanisms involved in AAC, focusing on the infectious causes. AAC associated with critical medical conditions is caused by bile stasis and gallbladder ischemia. Several mechanisms are reported to be involved in AAC in patients without underlying critical illness including direct invasion of the gallbladder epithelial cells, gallbladder vasculitis, obstruction of the biliary tree, and sequestration. We emphasize that multiple pathogenic mechanisms may concurrently contribute to the development of AAC in varying degrees. Awareness of the implicated pathogens is essential since it will allow a more focused examination of the histopathological specimens. In conclusion, additional research and a high degree of clinical suspicion are needed to clarify the complex spectrum of mechanisms that are involved in the pathogenesis of AAC.

Keywords: Cholecystitis; Infectious causes; Vasculitis; Sequestration; Epstein-Barr virus

Core Tip: The most important mechanisms involved in acute acalculous cholecystitis in patients without underlying critical illness are direct invasion of the gallbladder epithelial cells, gallbladder vasculitis, obstruction of the biliary tree, and sequestration. Awareness of the implicated pathogens is essential since it will allow a more focused examination of the histopathological specimens.