Acute Calculous Cholecystitis with Septic Shock — Management When Surgery Is Refused or Not Feasible

When a patient with acute calculous cholecystitis cannot undergo or refuses surgery — particularly in the presence of septic shock or absolute anaesthesiology contraindications — a specific, evidence-based pathway applies.

Clinical Scenario

Patient with acute calculous cholecystitis who refuses surgery or is not suitable for surgery, including cases complicated by septic shock or absolute anaesthesiology contraindications — in whom laparoscopic cholecystectomy is not a viable option.

Treatment Approach

Gallbladder drainage is the recommended intervention in this setting — the full protocol details which specific approach is appropriate based on local expertise and centre resources.

Clinical Goals

Conversion of a septic patient to a non-septic state
Reduction of inflammation
Improvement of overall clinical condition

Instant Access to Structured Evidence-Based Regimens

References

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.

We recommend performing gallbladder drainage in patients with ACC who are not suitable for surgery, as it converts a septic patient with ACC into a non-septic patient.

The removal of the infected material can result in reduced inflammation and in improvement of the clinical conditions.

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