الفهرس 
Surgical anatomy of the Biliary systemOnly 14 pages are availabe for public view
 |  | from | 139 |  |  |
| | | from | 139 | | |
Abstract
Acalculous cholecystitis could be defined as the presence of classic biliary symptoms in the absence of any stones or sludge. It can be classified into two main categories i.e acute and chronic acalculous cholecystitis (biliary dyskinesia) and the later is subdivided into gallbladder dyskinesia and biliary sphincter of Oddi dysfunction.
Acute acalculous cholecystitis accounts for about 5 to 14 % of all cases of acute cholecystitis and about 1 to 2 % of laparoscopic cholcystectomies. It tends to occur in males > 50 years. Primary cases are rare but it usually occurs secondary to other srious conditions e.g ICU patient, after major trauma, burns and major surgery.
The most reliable method for diagnosis of acute acalculous cholecystitis is the clinical suspicion supported by ultarsonographic features, and for the reason that the patient is usually critical suffering from other morbid conditions if the possibility of acute acalculous cholecystitis is not put in mind it can easily pass undignosed and carries a high mortality rate so surgical intervention in the form of urgent cholecystectomy or cholecystostomy is critical and life saving that is because acute acalculous cholecystitis rapidly progresses towords gallbladder perforation and biliary peritonitis.
Gallbladder dyskinesia tends to occur predominantly in females and it is considered a functional motility disorder of the gallbladder with still poorly understood pathophysiology and gallbladder scintigraphy with low ejection fraction is generally accepted as the most reliable method for diagnosis and most patients with low ejection fraction will be symptom free after cholecystectomy.
Biliary sphincter of Oddi dyfunction is usually diagnosed postoperatively (after cholecystectomy) in the majorty of cases and is known as post-cholecystectomy syndrome. It is best diagnosed by sphincter of Oddi manometry and effectively treated with endoscopic sphincterotomy.