Case Series of Acute Acalculous Cholecystitis in Non-icu Settings: Spectrum of Clinical Presentation, Imaging Findings, and Surgical Outcomes

A BSTRACT Background: Acute acalculous cholecystitis (AAC) is the acute inflammation of the gallbladder without gallstones, classically associated with critically ill patients in intensive care settings. However, a small proportion of patients may present with AAC in non-ICU settings, often posing diagnostic and therapeutic challenges. Pathogenesis is multifactorial, involving ischemia due to microvascular occlusion, sepsis, systemic comorbidities, or rarely direct bacterial invasion (e.g., Salmonella typhi, Campylobacter jejuni ). The inflammation may also coexist with gallbladder pathologies such as cholesterolosis, polyposis, adenomyomatosis, or xanthogranulomatous cholecystitis. Delay in diagnosis is common and increases morbidity. Methods: A prospective case series including nine patients with AAC presenting in non-ICU settings managed surgically between June 2024 and August 2025 was studied. Data collected on demographics, clinical presentation, comorbidities, laboratory findings, imaging features, operative procedures, histopathology, and postoperative outcomes were used for the study. Results: Patients’ age ranged from 32–84 years (mean 56), with a male predominance (7/9). Common comorbidities included hypertension (n = 3), diabetes mellitus (n = 2), and neurological or cardiac disease (n = 2). All the patients presented with acute abdominal pain, with additional symptoms of vomiting (n = 6), fever (n = 4), and abdominal distension (n = 2). Two had extraordinary presentations—hemobilia from a cystic artery pseudoaneurysm, and acute abdomen with respiratory distress in a Parkinson’s patient. Imaging revealed gallbladder distension, mural thickening, pericholecystic fluid, fat stranding (8/9), and complications such as perforation (6/9) or vascular pseudoaneurysm (1/9). Surgical management included laparoscopic cholecystectomy (n = 2), conversion to open cholecystectomy (n = 7, including 1 subtotal), percutaneous cholecystostomy (n = 2), and vascular coiling (n = 1). Histopathology confirmed gangrenous, perforative, necrotizing, xanthogranulomatous, and adenomyomatous variants. All the patients recovered without major postoperative complications. Conclusion: AAC in non-ICU settings presents with a wide clinical spectrum and high rates of complications. Early diagnosis aided by imaging, individualized surgical planning, and timely intervention ensures favorable outcomes even in high-risk patients.