For most patients, acute calculous cholecystitis is managed surgically. However, a specific population cannot undergo or declines that path — including those presenting with septic shock, absolute anaesthesiology contraindications, or those who refuse surgery. This page outlines the evidence-based approach for that scenario.
This protocol applies to patients with acute calculous cholecystitis in whom operative cholecystectomy is not feasible or has been declined.
When surgery cannot proceed, a non-operative management (NOM) strategy is indicated. This centres on best medical therapy combined with close clinical observation.
The complete structured regimen — including specific therapeutic components and decision criteria — is available in the full protocol.
DOI: 10.1186/s13017-020-00336-x
We suggest considering NOM, i.e. best medical therapy with antibiotics and observation, for patients refusing surgery or those who are not suitable for surgery.
We recommend avoiding laparoscopic cholecystectomy in case of septic shock or absolute anaesthesiology contraindications.
Conservative management with fluids, analgesia and antibiotics is an option for people with mildly symptomatic acute cholecystitis (i.e. people without peritonitis or those who have worsening clinical condition).
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