Steatocholecystitis: An Explanation For Increased Cholecystectomy Rates
Hayder Al-Azzawi1, Attila Nakeeb1, Romil Saxena2, Henry A. Pitt1; 1Department of Surgery, Indiana University , Indianapolis, IN; 2Department of Pathology, Indiana University, Indianapolis, IN
Introduction: Gallbladder disease represents a major health care problem in the United States. Over the past decade, the number of cholecystectomies and the percentage with chronic acalculous cholecystitis have increased. However, a good explanation for these trends has not been established. During the same period, obesity has become epidemic among Americans, and obesity is a known risk factor for gallbladder disease. We have recently reported that congenitally obese mice and lean mice fed a high fat diet have increased gallbladder wall lipids and poor gallbladder emptying. Therefore, we tested the hypothesis that compared to patients with a normal gallbladder, patients with both acalculous and calculous cholecystitis would have increased gallbladder wall fat and inflamation (steatocholecystitis). Methods: Eleven patients with impaired gallbladder emptying who underwent cholecystectomy for symptomatic chronic acalculous cholecystitis were identified. Twelve nondiseased controls without biliary symptoms who underwent incidental cholecystectomy during surgery for liver or pancreatic disease and 13 diseased controls who underwent cholecystectomy for symptomatic chronic calculous cholecystitis were chosen from a database of over 500 patients and were matched for gender, Body Mass Index (BMI) and surgeon to the acalculous cholecystitis patients. Acalculous cholecystitis and control demographics were recorded. Surgical pathology specimens from cases and controls were reviewed in a blinded fashion for gallbladder wall fat and inflammation (0→4+). Data were analyzed by Student’s t test. Results: Acalculous cholecystitis patients were younger (p<0.05) than nondiseased or diseased controls (41 vs 57 vs 57 years). Gallbladder (GB) wall thickness (mm), fat thickness (mm), % fat and inflammatory scores (IS) are presented in the table. Conclusions: These data suggest that compared to nondiseased controls 1)patients with acalculous cholecystitis are younger and have increased gallbladder fat and 2)patients with calculous cholecystitis have increased gallbladder fat and inflammation. We conclude that increased gallbladder fat may lead to poor gallbladder emptying and biliary symptoms. Thus, steatocholecystitis may explain, in part, the increased need for cholecystectomy and the higher percentage of these patients with acalculous cholecystitis.
| | GB Wall | GB Fat | % Fat | IS |
| Nondiseased Controls | 2.1±0.2 | 0.1±0.1 | 6.8±3.7 | 1.3±0.4 |
| Acalculous Cholecystitis | 1.6±0.2 | 0.6±0.2† | 33.6±8.9† | 1.5±0.3 |
| Calculous Cholecystitis | 3.2±0.5* | 1.1±0.3† | 34.9±6.9† | 2.9±0.3§ |
*p<0.03 vs Acalculous;†p<0.03 vs Controls;§p<0.001 vs Controls and Acalculous
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