Acute Cholecystitis in the Elderly Patient: How Is It Different?

  • Andrea J. HladikEmail author
  • Matthias Barden


The diagnosis and management of elderly patients with acute cholecystitis can be challenging due to less specific complaints, concomitant diseases, and broader differential diagnoses. Geriatric patients with cholecystitis often present without specific or localizing abdominal complaints, and laboratory testing may be unremarkable due to a less robust inflammatory response. Imaging modalities should be used liberally, and computed tomography may initially be more helpful than ultrasound. Once the diagnosis is made, treatment options vary for the elderly because of their comorbidities. Conservative, noninvasive initial management may be better than immediate surgical intervention.


Undifferentiated abdominal pain Cholecystitis Geriatrics Cholecystectomy 


  1. 1.
    Ozeki M, Takeda Y, Morita H, et al. Acute cholecystitis mimicking or accompanying cardiovascular disease among Japanese patients hospitalized in a hospital Cardiology Department. BMC Res Notes. 2015;8:805.CrossRefGoogle Scholar
  2. 2.
    Leuthauser A, McVane B. Abdominal pain in the geriatric patient. Emerg Med Clin N Am. 2016;34:363–75.CrossRefGoogle Scholar
  3. 3.
    Magidson PD, Martinez JP. Abdominal pain in the geriatric patient. Emerg Med Clin N Am. 2016;34:559–74.CrossRefGoogle Scholar
  4. 4.
    Zhang ZM, Liu Z, Liu LM, et al. Therapeutic experience of 289 elderly patients with biliary diseases. World J Gastroenterol. 2017;23:2424–34.CrossRefGoogle Scholar
  5. 5.
    Spangler R, Van Pham T, Khoujah D, et al. Abdominal emergencies in the geriatric patient. Int J Emerg Med. 2014;7:43.CrossRefGoogle Scholar
  6. 6.
    Fagenholz PJ. Computed tomography is more sensitive than ultrasound for the diagnosis of acute cholecystitis. Surg Infect. 2015;16:509–12.CrossRefGoogle Scholar
  7. 7.
    Pinto A, Reginelli A, Cagini L, et al. Accuracy of ultrasonography in the diagnosis of acute calculous cholecystitis: review of the literature. Crit Ultrasound J. 2013;5:S11.CrossRefGoogle Scholar
  8. 8.
    Hsieh YC, Chen CK, Su CW, et al. Outcome after percutaneous cholecystostomy for acute cholecystitis: a single-center experience. J Gastrointest Surg. 2012;16:1860–8.CrossRefGoogle Scholar
  9. 9.
    Lee SI, Na BG, Yoo YS, et al. Clinical outcome for laparoscopic cholecystectomy in extremely elderly patients. Ann Surg Treat Res. 2015;88:145–51.CrossRefGoogle Scholar
  10. 10.
    Venara A, Carretier V, Lebigot J, Lermite E. Technique and indications of percutaneous cholecystostomy in the management of cholecystitis in 2014. J Visc Surg. 2014;151:435–9.CrossRefGoogle Scholar
  11. 11.
    Lee S, Park DH, Hwang CY, et al. EUS-guided transmural cholecystostomy as rescue management for acute cholecystitis in elderly or high-risk patients: a prospective feasibility study. Gastrointest Endosc. 2007;66:1008–12.CrossRefGoogle Scholar
  12. 12.
    Cherng N, Witkowski ET, Sneider EB, et al. Use of cholecystostomy tubes in the management of patients with primary diagnosis of acute cholecystitis. J Am Coll Surg. 2012;214:196–201.CrossRefGoogle Scholar
  13. 13.
    Wang CH, Wu CY, Yang JCT, et al. Long-term outcomes of patients with acute cholecystitis after successful percutaneous cholecystostomy treatment and the risk factors for recurrence: a decade experience at a single center. PLoS One. 2016;11:e0148017.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Emergency MedicineEisenhower Medical CenterRancho MirageUSA

Personalised recommendations