Skip to main content

Acute Acalculous Cholecystitis

  • Chapter
  • First Online:

Abstract

Acute acalculous cholecystitis (AAC) is defined as an acute necro-inflammatory disease of the gallbladder in the absence of cholelithiasis and has a multifactorial pathogenesis [1, 2]. It was first reported by Duncan in 1844 when reporting a fatal case of AAC complicating an incarcerated hernia. AAC affects both adults and children although certain demographics are susceptible depending on the underlying illness. Although the incidence of AAC has been rising steadily since the 1970s [3], the true incidence remains difficult to determine.

This is a preview of subscription content, log in via an institution.

References

  1. Owen CC, Jain R. Acute acalculous cholecystitis. Curr Treat Options Gastroenterol. 2005;8(2):99–104.

    PubMed  Google Scholar 

  2. Barie PS, Eachempati SR. Acute acalculous cholecystitis. Gastroenterol Clin N Am. 2010;39(2):343–57. x

    Google Scholar 

  3. Glenn F, Becker CG. Acute acalculous cholecystitis. An increasing entity. Ann Surg. 1982;195(2):131–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  4. Ryu JK, Ryu KH, Kim KH. Clinical features of acute acalculous cholecystitis. J Clin Gastroenterol. 2003;36(2):166–9.

    PubMed  Google Scholar 

  5. Kalliafas S, et al. Acute acalculous cholecystitis: incidence, risk factors, diagnosis, and outcome. Am Surg. 1998;64(5):471–5.

    CAS  PubMed  Google Scholar 

  6. Liu F-L, et al. Acute acalculous cholecystitis immediately after gastric operation: case report and literatures review. World J Gastroenterol. 2014;20(30):10642–50.

    PubMed  PubMed Central  Google Scholar 

  7. Abdur-Rahman OL, Adeniran OJ, Nasir AA. Outcome of acalculous cholecystitis from typhoid in Nigerian children. J Natl Med Assoc. 2009;101(7):717–9.

    PubMed  Google Scholar 

  8. Axelrod D, Karakas SP. Acalculous cholecystitis and abscess as a manifestation of typhoid fever. Pediatr Radiol. 2007;37(2):237.

    PubMed  Google Scholar 

  9. Benjelloun el B, et al. A case report of acute acalculous cholecystitis due to Salmonella Paratyphi B complicated by biliary peritonitis. Pan Afr Med J. 2013;16:127.

    PubMed  PubMed Central  Google Scholar 

  10. Commons R, Dimitriou J, Campbell I. Acalculous cholecystitis caused by Salmonella virchow. ANZ J Surg. 2008;78(6):514.

    PubMed  Google Scholar 

  11. Udayakumar D, Sanaullah M. Campylobacter cholecystitis. Int J Med Sci. 2009;6(6):374–5.

    PubMed  PubMed Central  Google Scholar 

  12. Brewer L, et al. Streptococcus agalactiae endocarditis presenting as acalculous cholecystitis in a previously well woman. BMJ Case Rep. 2013. https://doi.org/10.1136/bcr-2012-008278.

    Google Scholar 

  13. Chen PL, et al. Respiratory failure and acalculous cholecystitis in a patient with AIDS and disseminated tuberculosis: masking effect of fluoroquinolone monotherapy and immune restoration syndrome. Int J Infect Dis. 2009;13(4):e165–8.

    PubMed  Google Scholar 

  14. Chong VH, Goh SK. Leptospirosis presenting as acute acalculous cholecystitis and pancreatitis. Ann Acad Med Singap. 2007;36(3):215–6.

    PubMed  Google Scholar 

  15. Dezsi CA, et al. Empyema thoracis, hemorrhagic pericarditis and acalculous cholecystitis caused by Eikenella corrodens sepsis. Orv Hetil. 2013;154(47):1873–6.

    PubMed  Google Scholar 

  16. Ergas D, Abdul-Hai A, Sthoeger ZM. Acalculous cholecystitis: an unusual presentation of acute Q fever masquerading as infectious endocarditis. Am J Med Sci. 2008;336(4):356–7.

    PubMed  Google Scholar 

  17. Figtree M, et al. Q fever cholecystitis in an unvaccinated butcher diagnosed by gallbladder polymerase chain reaction. Vector Borne Zoonotic Dis. 2010;10(4):421–3.

    PubMed  Google Scholar 

  18. Kim JH, et al. First report of human acute acalculous cholecystitis caused by the fish pathogen Lactococcus garvieae. J Clin Microbiol. 2013;51(2):712–4.

    PubMed  PubMed Central  Google Scholar 

  19. Tena D, et al. Acute acalculous cholecystitis complicated with peritonitis caused by Lactobacillus plantarum. Diagn Microbiol Infect Dis. 2013;76(4):510–2.

    PubMed  Google Scholar 

  20. Agholi M, et al. First detection of acalculous cholecystitis associated with Sarcocystis infection in a patient with AIDS. Acta Parasitol. 2014;59(2):310–5.

    PubMed  Google Scholar 

  21. Alave J, et al. Acalculous Cholecystitis caused by Histoplasma capsulatum in a severely immunosuppressed HIV-infected patient. J Infect Dev Ctries. 2011;5(3):235–8.

    PubMed  Google Scholar 

  22. Arya SO, et al. Epstein Barr virus-associated acute acalculous cholecystitis: a rare occurrence but favorable outcome. Clin Pediatr. 2010;49(8):799–804.

    Google Scholar 

  23. Attilakos A, et al. Acute acalculous cholecystitis in children with Epstein-Barr virus infection: a role for Gilbert's syndrome? Int J Infect Dis. 2009;13(4):e161–4.

    PubMed  Google Scholar 

  24. Chalupa P, Kaspar M, Holub M. Acute acalculous cholecystitis with pericholecystitis in a patient with Epstein-Barr virus infectious mononucleosis. Med Sci Monit. 2009;15(2):CS30–3.

    PubMed  Google Scholar 

  25. Basar O, et al. An unusual cause of acalculous cholecystitis during pregnancy: hepatitis A virus. Dig Dis Sci. 2005;50(8):1532.

    PubMed  Google Scholar 

  26. Bouyahia O, et al. Hepatitis A: a rare cause of acalculous cholecystitis in children. Med Maladies Infect. 2008;38(1):34–5.

    CAS  Google Scholar 

  27. Fuoti M, et al. Acute acalculous cholecystitis as a complication of hepatitis A: report of 2 pediatric cases. Pediatr Med Chir. 2008;30(2):102–5.

    CAS  PubMed  Google Scholar 

  28. Tresallet C, et al. Hepatitis C virus infection revealed by an acute acalculous cholecystitis. J Radiol. 2010;91(7–8):813–5.

    CAS  PubMed  Google Scholar 

  29. Berrington WR, Hitti J, Casper C. A case report of dengue virus infection and acalculous cholecystitis in a pregnant returning traveler. Travel Med Infect Dis. 2007;5(4):251–3.

    PubMed  PubMed Central  Google Scholar 

  30. Bhatty S, et al. Acute acalculous cholecystitis in dengue fever. J Pak Med Assoc. 2009;59(8):519–21.

    PubMed  Google Scholar 

  31. Goh BK, Tan SG. Case of dengue virus infection presenting with acute acalculous cholecystitis. J Gastroenterol Hepatol. 2006;21(5):923–4.

    PubMed  Google Scholar 

  32. Brent AJ, et al. Acute cholecystitis complicating mumps. Clin Infect Dis. 2006;42(2):302–3.

    CAS  PubMed  Google Scholar 

  33. Frohlich R, Rommele U. Acalculous cholecystitis in hantavirus infections. Dtsch Med Wochenschr. 2013;138(23):1255–8.

    CAS  PubMed  Google Scholar 

  34. Gora-Gebka M, et al. Acute acalculous cholecystitis of viral etiology—a rare condition in children? J Pediatr Surg. 2008;43(1):e25–7.

    PubMed  Google Scholar 

  35. Guner R, et al. A case of Crimean Congo hemorrhagic fever complicated with acalculous cholecystitis and intraabdominal abscess. J Clin Virol. 2011;50(2):162–3.

    CAS  PubMed  Google Scholar 

  36. Abreu C, et al. Acute acalculous cholecystitis in malaria: a review of seven cases from an adult cohort. Infection. 2013;41(4):821–6.

    CAS  PubMed  Google Scholar 

  37. Carvalho D, et al. Acute acalculous cholecystitis in a patient with severe malaria. Acta Medica Portuguesa. 2011;24(Suppl 3):631–4.

    PubMed  Google Scholar 

  38. Hayakawa K, et al. A case of scrub typhus with acalculous cholecystitis, aseptic meningitis and mononeuritis multiplex. J Med Microbiol. 2012;61(Pt 2):291–4.

    PubMed  Google Scholar 

  39. Malik AA, Wani RA, Bari S. Acute acalculous cholecystitis due to Taenia saginata. Ann Saudi Med. 2008;28(5):388–9.

    PubMed  PubMed Central  Google Scholar 

  40. Grosser J, Solomon H, Sotelo-Avila C. Acalculous candidal cholecystitis after pediatric renal transplant. Pediatr Transplant. 2011;15(4):E71–5.

    PubMed  Google Scholar 

  41. Bando H, et al. Acute acalculous cholecystitis induced by mesenteric inflammatory veno-occlusive disease (MIVOD) in systemic lupus erythematosus. Clin Rheumatol. 2003;22(6):447–9.

    PubMed  Google Scholar 

  42. Basiratnia M, et al. Acute acalculous cholecystitis in a child with systemic lupus erythematosus. Pediatr Nephrol. 2006;21(6):873–6.

    PubMed  Google Scholar 

  43. Cheng YL, Lee KC, Luo JC. A young woman presenting with jaundice. Gastroenterology. 2012;143(2):e1–2.

    PubMed  Google Scholar 

  44. Chen CJ, et al. Sonographic gallbladder abnormality is associated with intravenous immunoglobulin resistance in Kawasaki disease. Scientific World J. 2012;2012:485758.

    Google Scholar 

  45. Francescutti V, et al. Acute acalculous cholecystitis: an unusual presenting feature of Churg-Strauss vasculitis. Can J Surg. 2008;51(6):E129–30.

    PubMed  PubMed Central  Google Scholar 

  46. Hegarty J, et al. Systemic lupus erythematosus, eosinophilic vasculitis and acalculous cholecystitis. Nephrol Dial Transplant. 2006;21(3):792–5.

    PubMed  Google Scholar 

  47. Meier M, Holl-Ulrich K, Perras B. A rare manifestation of cryoglobulinemic vasculitis: acalculous cholecystitis. Clin Gastroenterol Hepatol. 2005;3(10):xxvi.

    PubMed  Google Scholar 

  48. Kara E, Ayden H. Antiphospholipid antibody syndrome (APS) presenting as splenic thrombosis and acute acalculous cholecystitis. Acta Chir Belg. 2004;104(6):733–5.

    CAS  PubMed  Google Scholar 

  49. Sanches BF, et al. Acute acalculous cholecystitis in a patient with juvenile dermatomyositis. BMJ Case Rep. 2014. https://doi.org/10.1136/bcr-2014-205066.

    Google Scholar 

  50. Wang AJ, et al. Clinical predictors of severe gallbladder complications in acute acalculous cholecystitis. World J Gastroenterol. 2003;9(12):2821–3.

    PubMed  PubMed Central  Google Scholar 

  51. Hill AG, Collins JP. Acute acalculous cholecystitis. Aust N Z J Surg. 1994;64(4):251–3.

    CAS  PubMed  Google Scholar 

  52. Inagaki FF, et al. Acute and chronic acalculous cholecystitis associated with aortic dissection. J Surg Case Rep. 2015;2015(8):rjv101.

    PubMed  PubMed Central  Google Scholar 

  53. Sogutlu G, et al. Acute acalculous cholecystitis induced by aortic dissection: report of a case. TJTES. 2010;16(3):283–5.

    PubMed  Google Scholar 

  54. Bai LY, et al. Acalculous cholecystitis mimicking plasma cell leukemia. Ann Hematol. 2006;85(7):487–8.

    PubMed  Google Scholar 

  55. Bilanovic D, et al. Granular cell tumor of the common hepatic duct presenting as cholangiocarcinoma and acute acalculous cholecystitis. Acta Chir Iugosl. 2008;55(4):99–101.

    CAS  PubMed  Google Scholar 

  56. Takeda K, et al. Unusual presentation of multiple recurrent cardiac sarcomas as acute acalculous cholecystitis caused by rapid expansion into the right cardiac chamber: report of a case. Surg Today. 2012;42(5):479–81.

    PubMed  Google Scholar 

  57. Ahmed N. Acute acalculous cholecystitis complicating major trauma: a report of five cases. South Med J. 2008;101(11):1146–9.

    PubMed  Google Scholar 

  58. Buffone A, et al. Acute postoperative acalculous cholecystitis. Chir Ital. 2005;57(6):743–8.

    PubMed  Google Scholar 

  59. Iwata T, et al. A case of acalcuous cholecystitis developed after cardiopulmonary resuscitation. J UOEH. 2009;31(1):57–62.

    PubMed  Google Scholar 

  60. Katsinelos P, et al. Fatal acute acalculous cholecystitis as an early complication after radiation therapy. Chirurgia (Bucuresti). 2008;103(2):223–6.

    CAS  Google Scholar 

  61. Miloh T, et al. T-cell PTLD presenting as acalculous cholecystitis. Pediatr Transplant. 2008;12(6):717–20.

    PubMed  Google Scholar 

  62. Senthilkumaran S, et al. Acute acalculous cholecystitis: a rare complication of snake bite. Wilderness Environ Med. 2013;24(3):277–9.

    PubMed  Google Scholar 

  63. Shin YH, et al. A five-year-old boy with nephrotic syndrome complicated with acute acalculous cholecystitis. Pediatr Int. 2007;49(5):674–6.

    PubMed  Google Scholar 

  64. Milone M, et al. Acute acalculous cholecystitis determining Mirizzi syndrome: case report and literature review. BMC Surg. 2014;14:90.

    PubMed  PubMed Central  Google Scholar 

  65. Rojo P, et al. Outpatient treatment with corticosteroids and antibiotics for acalculous cholecystitis in chronic granulomatous disease. Acta Paediatr. 2005;94(11):1684–6.

    PubMed  Google Scholar 

  66. Shridhar Ganpathi I, et al. Acute acalculous cholecystitis: challenging the myths. HPB (Oxford). 2007;9(2):131–4.

    Google Scholar 

  67. Chen PF, et al. The clinical diagnosis of chronic acalculous cholecystitis. Surgery. 2001;130(4):578–81. discussion 581-3.

    CAS  PubMed  Google Scholar 

  68. Theodorou P, et al. Acalculous cholecystitis in severely burned patients: incidence and predisposing factors. Burns. 2009;35(3):405–11.

    CAS  PubMed  Google Scholar 

  69. Sessions SC, et al. Acute acalculous cholecystitis following open heart surgery. Am Surg. 1993;59(2):74–7.

    CAS  PubMed  Google Scholar 

  70. Wendel AV. VI. A case of floating gall-bladder and kidney complicated by cholelithiasis, with perforation of the gall-bladder. Ann Surg. 1898;27(2):199–202.

    CAS  PubMed  PubMed Central  Google Scholar 

  71. Shaikh AA, et al. Gallbladder volvulus: report of two original cases and review of the literature. Am Surg. 2005;71(1):87–9.

    PubMed  Google Scholar 

  72. Cornwell EE, et al. Acute acalculous cholecystitis in critically injured patients. Preoperative diagnostic imaging. Ann Surg. 1989;210(1):52–5.

    PubMed  PubMed Central  Google Scholar 

  73. McChesney JA, Northup PG, Bickston SJ. Acute acalculous cholecystitis associated with systemic sepsis and visceral arterial hypoperfusion: a case series and review of pathophysiology. Dig Dis Sci. 2003;48(10):1960–7.

    PubMed  Google Scholar 

  74. Thomas CG Jr, Womack NA. Acute cholecystitis, its pathogenesis and repair. AMA Arch Surg. 1952;64(5):590–600.

    PubMed  Google Scholar 

  75. Matsusaki S, et al. Clinical features of acute acalculous cholecystits-nosocomial manner and community-acquired manner. Nihon Shokakibyo Gakkai Zasshi. 2008;105(12):1749–57.

    PubMed  Google Scholar 

  76. Cullen JJ, et al. Effect of endotoxin on opossum gallbladder motility: a model of acalculous cholecystitis. Ann Surg. 2000;232(2):202–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  77. Orlando R III, Gleason E, Drezner AD. Acute acalculous cholecystitis in the critically ill patient. Am J Surg. 1983;145(4):472–6.

    PubMed  Google Scholar 

  78. Hakala T, et al. Microangiopathy in acute acalculous cholecystitis. Br J Surg. 1997;84(9):1249–52.

    CAS  PubMed  Google Scholar 

  79. Kaminski DL, et al. Studies on the etiology of acute acalculous cholecystitis: the effect of lipopolysaccharide on human gallbladder mucosal cells. Prostaglandins. 1994;47(4):319–30.

    CAS  PubMed  Google Scholar 

  80. Taoka H. Experimental study on the pathogenesis of acute acalculous cholecystitis, with special reference to the roles of microcirculatory disturbances, free radicals and membrane-bound phospholipase A2. Gastroenterol Jpn. 1991;26(5):633–44.

    CAS  PubMed  Google Scholar 

  81. Mouawad NJ, et al. Acute gallbladder torsion—a continued pre-operative diagnostic dilemma. World J Emerg Surg. 2011;6(1):1749–7922.

    Google Scholar 

  82. Laurila JJ, et al. Histopathology of acute acalculous cholecystitis in critically ill patients. Histopathology. 2005;47(5):485–92.

    CAS  PubMed  Google Scholar 

  83. Laurila JJ, et al. Tight junction proteins in gallbladder epithelium: different expression in acute acalculous and calculous cholecystitis. J Histochem Cytochem. 2007;55(6):567–73.

    CAS  PubMed  Google Scholar 

  84. Vakkala M, et al. Cellular turnover and expression of hypoxic-inducible factor in acute acalculous and calculous cholecystitis. Crit Care. 2007;11(5):R116.

    PubMed  PubMed Central  Google Scholar 

  85. Kaminski DL, et al. The role of prostanoids in the production of acute acalculous cholecystitis by platelet-activating factor. Ann Surg. 1990;212(4):455–61.

    CAS  PubMed  PubMed Central  Google Scholar 

  86. Goenka U, et al. Spontaneous perforation of acalculous gall bladder presenting as acute abdomen. J Emerg Med. 2012;43(4):637–40.

    PubMed  Google Scholar 

  87. Pelinka LE, et al. Acute acalculous cholecystitis after trauma: a prospective study. J Trauma. 2003;55(2):323–9.

    PubMed  Google Scholar 

  88. Ueno D, et al. Emergent laparoscopic cholecystectomy for acute acalculous cholecystitis revisited. Surg Today. 2015;24:24.

    Google Scholar 

  89. Tsakayannis DE, Kozakewich HPW, Lillehei CW. Acalculous cholecystitis in children. J Pediatr Surg. 1996;31(1):127–31.

    CAS  PubMed  Google Scholar 

  90. Puc MM, et al. Ultrasound is not a useful screening tool for acute acalculous cholecystitis in critically ill trauma patients. Am Surg. 2002;68(1):65.

    PubMed  Google Scholar 

  91. Mirvis SE, et al. The diagnosis of acute acalculous cholecystitis: a comparison of sonography, scintigraphy, and CT. Am J Roentgenol. 1986;147(6):1171–5.

    CAS  Google Scholar 

  92. Prevot N, et al. Contribution of cholescintigraphy to the early diagnosis of acute acalculous cholecystitis in intensive-care-unit patients. Eur J Nucl Med. 1999;26(10):1317–25.

    CAS  PubMed  Google Scholar 

  93. Mariat G, et al. Contribution of ultrasonography and cholescintigraphy to the diagnosis of acute acalculous cholecystitis in intensive care unit patients. Intensive Care Med. 2000;26(11):1658–63.

    CAS  PubMed  Google Scholar 

  94. Deitch EA, Engel JM. Ultrasound in elective biliary tract surgery. Am J Surg. 1980;140(2):277–83.

    CAS  PubMed  Google Scholar 

  95. Ahvenjarvi L, et al. Diagnostic accuracy of computed tomography imaging of surgically treated acute acalculous cholecystitis in critically ill patients. J Trauma. 2011;70(1):183–8.

    PubMed  Google Scholar 

  96. Blankenberg F, et al. Computed tomography as an adjunct to ultrasound in the diagnosis of acute acalculous cholecystitis. Gastrointest Radiol. 1991;16(1):149–53.

    CAS  PubMed  Google Scholar 

  97. İmamoğlu M, et al. Acute acalculous cholecystitis in children: diagnosis and treatment. J Pediatr Surg. 2002;37(1):36–9.

    PubMed  Google Scholar 

  98. Guidelines for diagnostic laparoscopy. Society of American Gastroenterological and Endoscopic Surgeons 10th October 2015. www.sages.org/publications/guidelines.

  99. Brandt CP, Priebe PP, Jacobs DG. Value of laparoscopy in trauma ICU patients with suspected acute acalculous cholecystitis. Surg Endosc. 1994;8(5):361–4. discussion 364-5

    CAS  PubMed  Google Scholar 

  100. Gagné DJ, et al. Bedside diagnostic minilaparoscopy in the intensive care patient. Surgery. 2002;131(5):491–6.

    PubMed  Google Scholar 

  101. Gu MG, et al. Risk factors and therapeutic outcomes of acute acalculous cholecystitis. Digestion. 2014;90(2):75–80.

    PubMed  Google Scholar 

  102. Huffman JL, Schenker S. Acute acalculous cholecystitis: a review. Clin Gastroenterol Hepatol. 2010;8(1):15–22.

    PubMed  Google Scholar 

  103. Anderson JE, et al. Cholecystostomy offers no survival benefit in patients with acute acalculous cholecystitis and severe sepsis and shock. J Surg Res. 2014;190(2):517–21.

    PubMed  Google Scholar 

  104. Poole GH, Yellapu S. Acute laparoscopic cholecystectomy. A case controlled study. Surg Endosc. 2000;14(2):106–9.

    CAS  PubMed  Google Scholar 

  105. Chung YH, et al. Can percutaneous cholecystostomy be a definitive management for acute acalculous cholecystitis? J Clin Gastroenterol. 2012;46(3):216–9.

    PubMed  Google Scholar 

  106. Smith TJ, et al. Changing trends and outcomes in the use of percutaneous cholecystostomy tubes for acute cholecystitis. Ann Surg. 2013;257(6):1112–5.

    PubMed  Google Scholar 

  107. Boland GW, et al. Percutaneous cholecystostomy in critically ill patients: early response and final outcome in 82 patients. AJR Am J Roentgenol. 1994;163(2):339–42.

    CAS  PubMed  Google Scholar 

  108. Cherng N, et al. Use of cholecystostomy tubes in the management of patients with primary diagnosis of acute cholecystitis. J Am Coll Surg. 2012;214(2):196–201.

    PubMed  Google Scholar 

  109. Yang HK, Hodgson WJ. Laparoscopic cholecystostomy for acute acalculous cholecystitis. Surg Endosc. 1996;10(6):673–5.

    CAS  PubMed  Google Scholar 

  110. Carr HA. A short history of the Foley catheter: from handmade instrument to infection-prevention device. J Endourol. 2000;14(1):5–8.

    CAS  PubMed  Google Scholar 

  111. Johlin FC Jr, Neil GA. Drainage of the gallbladder in patients with acute acalculous cholecystitis by transpapillary endoscopic cholecystotomy. Gastrointest Endosc. 1993;39(5):645–51.

    PubMed  Google Scholar 

  112. Ford JA, et al. Systematic review of intraoperative cholangiography in cholecystectomy. Br J Surg. 2012;99(2):160–7.

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding authors

Correspondence to Bruce Su’a , Andrew G. Hill or Garth H. Poole .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Su’a, B., Hill, A.G., Poole, G.H. (2018). Acute Acalculous Cholecystitis. In: Cox, M., Eslick, G., Padbury, R. (eds) The Management of Gallstone Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-63884-3_11

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-63884-3_11

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-63882-9

  • Online ISBN: 978-3-319-63884-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics