What Is Acalculous Gallbladder Disease?

Inflammation of the gallbladder without the presence of gallstones

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Acalculous gallbladder disease is a type of cholecystitis, or inflammation of the gallbladder. This type does not involve the presence of gallstones, which are small, crystal-like masses that can form in the organ.

The other type, calculous cholecystitis, is caused by gallstones. Interestingly, the symptoms of acalculous gallbladder disease are similar to those of this other form of gallbladder inflammation.

Acalculous gallbladder disease symptoms can be chronic (slowly progressing with intermittent or vague symptoms) or acute (sudden and severe). Acalculous gallbladder disease accounts for up to 10% of cholecystitis cases and is more common in people who are critically ill, such as those in the intensive care unit (ICU).

The complications of acalculous gallbladder disease can be very significant and it is considered a potentially life-threatening disorder.

Woman with stomach ache lying on the sofa
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Acalculous Gallbladder Disease Symptoms

Symptoms of acalculous gallbladder disease can be difficult to differentiate from other inflammatory conditions of the gallbladder. Mild symptoms may include:

  • Belching and gas
  • Nausea and vomiting
  • Food intolerance and discomfort after eating
  • Chronic diarrhea

Severe symptoms may develop abruptly. The onset of severe symptoms may include:

  • Severe right upper quadrant abdominal pain, under the rib cage
  • Fever
  • Symptoms of acute cholecystitis (including nausea and vomiting, fever, chills, yellowish tinge to the whites of the eyes or skin, bloating of the abdomen, pain that typically occurs after a meal)
  • Distended gallbladder that a healthcare provider can palpate (feel) upon physical examination
  • Elevation of white blood cells (which is usually present, but not always)

A chronic (slow to develop) form of acalculous gallbladder disease can be present. In chronic acalculous cholecystitis, symptoms are more prolonged and may be less severe. Symptoms may also be more intermittent and vague.

In acute acalculous gallbladder disease, a person is very ill, may have septicemia (a bacterial infection in the bloodstream), and is often in a hospital setting for some type of serious illness or a recovery from major surgery.


Significant and potentially fatal complications may arise with acalculous gallbladder disease, including:

  • Gangrene, which causes gallbladder tissue decay and death if the pressure is not relieved
  • Perforation, with a hole in the gallbladder wall that can lead to pericholecystic abscess
  • Sepsis, a severe infection of the bloodstream that can lead to death if not treated promptly


Various responses in the body may give rise to acalculous gallbladder disease:

  • Severe inflammation of the gallbladder
  • A build-up of pressure in the gallbladder from stasis, a lack of normal flow of bile
  • Ischemia, meaning a lack of adequate oxygenation in the gallbladder wall
  • Bacterial growth in the gallbladder, which can occur when bile stops flowing properly

There are many different underlying causes of gallbladder dysfunction, with common ones including:

  • Fasting for long periods of time
  • Dramatic weight loss
  • Long periods of total parenteral nutrition (TPN), which is intravenous nutritional feeding and hydration
  • Gallbladder stasis (a condition involving a lack of gallbladder stimulation that leads to an increase in the concentration of bile salts and a build-up of pressure in the gallbladder)
  • Decreased function of gallbladder emptying
  • Hypokinetic biliary dyskinesia (impaired gallbladder emptying, which may result from many different factors)

Those at Greater Risk for Acalculous Gallbladder Disease

The risk of acalculous gallbladder disease is higher if you have a contributing factor such as a long-term illness, severe trauma such as third-degree burns, or a serious medical condition.

Factors that can make you more likely to develop acalculous gallbladder disease include:

  • Noninfectious conditions of the liver and biliary tract (liver, gallbladder, and bile ducts that store and secrete bile)
  • Acute hepatitis, an infection of the liver
  • Other forms of hepatitis
  • Wilson's disease, a genetic disorder involving a harmful accumulation of copper in the body
  • Gallbladder polyps (abnormal growths)
  • Systemic infectious diseases that impact the entire body, such as bacteremia
  • Human immunodeficiency virus (HIV) infection and other illnesses that suppress the immune system
  • Viral infections such as Ebstein-Barr virus (EBV) or cytomegalovirus
  • Bacterial infections such as Group B Streptococcus, Salmonella typhi, and Helicobacter pylori
  • Giardia lamblia (a parasitic infection contracted from drinking water)
  • Severe physical trauma such as third-degree burns
  • Heart surgery
  • Abdominal surgery
  • Diabetes


Several techniques are used to complete an acalculous gallbladder disease test and arrive at a diagnosis. A liver function test (involving blood samples sent to the lab) is taken to check for elevated aminotransferases, alkaline phosphatase, and bilirubin levels.

Ultrasound imaging also is used to diagnose acalculous gallbladder disease. The ultrasound may show thickening of the gallbladder wall.

If the test results from ultrasound are uncertain, your healthcare provider may order a cholescintigraphy nuclear scan (HIDA) with the administration of cholecystokinin (CCK).

What Is a HIDA Scan?

A HIDA scan begins with a radioactive tracer injected into an arm vein, from which it travels to the liver. Liver cells that produce bile take up the tracer, which travels through the bile, gallbladder, and small intestine. Computer images are used to monitor for any gallbladder dysfunction, which may indicate acalculous gallbladder disease.

Differential Diagnosis

Differential diagnosis involves distinguishing a particular disease from others with similar signs and symptoms.

When a person has acalculous gallbladder disease, there are several other disorders that may need to be ruled out. They include:

  • Acute cholangitis (an infection in the bile ducts)
  • Acute cholecystitis
  • Pancreatitis (inflammation of the pancreas)
  • Hepatitis (inflammation of the liver)

Acalculous Gallbladder Disease Treatment

Acalculous gallbladder disease treatment depends on how severe the condition is. A person who has severe symptoms (such as septicemia) will initially need to be stabilized. 

Relieving the pressure that has built up in the gallbladder will be a top priority. This can be accomplished by the placement of a drainage tube in the gallbladder. If a bacterial infection is present, antibiotics will be given to help stabilize the patient.

If the condition is chronic, and the person with acalculous gallbladder disease is stable, it will be treated the same as an inflammation of the gallbladder with stones.

This will involve either traditional (open) surgery, involving a large incision to expose the surgical site, or laparoscopic surgery done with a laparoscope through very small incisions to remove the gallbladder (cholecystectomy).

If a person develops a gangrenous gallbladder, an emergency cholecystectomy will be performed right away.

Standard treatment of acalculous gallbladder disease usually involves giving broad-spectrum antibiotics, which are those that can inhibit the growth of or kill a wide variety of different pathogens).

If the person is too unstable for surgery, drainage techniques may be needed before the gallbladder removal can be performed. The healthcare provider may perform an endoscopy (a surgical procedure involving a thin tube with a camera) to surgically insert a stent to decompress the pressure.

This is done to to lower the risk of serious complications such as perforation, gangrene, or sepsis.

A Word From Verywell

Be sure to seek immediate medical attention if you have symptoms of gallbladder disease. That's even more important if you have risk factors such as diabetes, and experience severe upper right quadrant abdominal pain, nausea and vomiting, and other symptoms.

Frequently Asked Questions

  • What is the survival rate for acute acalculous gallbladder disease?

    Acute acalculous gallbladder disease often occurs in critically ill, hospitalized, or otherwise at-risk people. Roughly one in three people die because of it. Early diagnosis and treatment are key. Without that, mortality rises to 50%.

  • Is surgery always needed to treat acute acalculous gallbladder disease?

    Gallbladder removal is typically considered the best treatment option, but many high-risk people cannot tolerate it. A drainage catheter can be placed instead or until a surgery can be done. Antibiotics are also given to treat infection.

  • Can acalculous gallbladder disease be treated with diet changes?

    Not usually. But once your healthcare provider has treated your acalculous gallbladder disease through other options, it's likely you'll need to make changes to your diet. They include less fat, more fiber, and more fresh fruits and vegetables.

10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Sherry Christiansen
Sherry Christiansen is a medical writer with a healthcare background. She has worked in the hospital setting and collaborated on Alzheimer's research.