Which statements about acute acalculous cholecystitis are correct?

A. The disease is often accompanied by or associated with other conditions.

B. The diagnosis is often difficult.

C. The mortality rate is higher than that for acute calculous cholecystitis.

D. The disease has been treated successfully by percutaneous cholecystostomy. 

DISCUSSION: About half of the cases of acute acalculous cholecystitis are associated with other conditions, including sepsis, sarcoidosis, polyarteritis nodosa, and systemic lupus erythematosus. A majority of cases occur after trauma, burns, or major surgical procedures performed for other conditions. The precise pathogenesis has not been determined. The diagnosis of acute acalculous cholecystitis is often difficult because symptoms may be masked by another illness, injury, or the postoperative state. Unlike acute calculous cholecystitis, in which pain is always present, pain occurs in only about 70% of cases. In addition, cholescintigraphy is sometimes inaccurate. These factors make the diagnosis difficult, and a high index of suspicion is necessary, especially in patients who have had operations or trauma. Unexplained abdominal pain, sepsis, and ileus should prompt a thorough investigation. The mortality rate for acute acalculous cholecystitis is higher than that of the calculous type. The incidence of gangrene and perforation of the gallbladder is higher. The accompanying illnesses and conditions and the frequent delays in diagnosis undoubtedly contribute to the higher death rate. Percutaneous cholecystostomy has been used as a diagnostic and therapeutic maneuver in patients who are thought to have acute acalculous cholecystitis. Aspiration and culture of bile assist in confirming the diagnosis, and continuous drainage successfully treats the acute condition. Surprisingly, persistent gangrene and subsequent complications have been infrequent. Immediate cholecystectomy should be done if significant improvement does not take place within 12 hours of percutaneous cholecystostomy. Long-term management of the tube and the need for elective cholecystectomy must be individualized. The experience with percutaneous cholecystostomy is too small to determine whether this technique reduces the mortality rate.