Acute Cholecystitis (Gallbladder Inflammation)

Written by Mr. Panduka Jayawardena on 28.4.2021

Medically Reviewed by Dr. K on 28 April 2021

Acute Cholecystitis

Up to 12% of men and 24% of women have gallstones and most are asymptomatic, meaning that they do not show any symptoms of having gallstones (7). A small number of patients with gallstones will be treated for complications that arise due to having these gallstones.

Acute cholecystitis is an acute inflammation of the gallbladder due to obstruction of the cystic duct (a small structure that carries bile from the gallbladder) by a gallstone (1). In 5%-14% acute cholecystitis can occur without gallstones which are called Acalculous Cholecystitis (2).

Symptoms of Acute Cholecystitis

Acute Cholecystitis is suspected in patients with right upper or epigastric abdominal pain that radiates to the back on the right side and/or right shoulder, which becomes worse after eating. In addition to pain, the patient may experience nausea and vomiting, and fever (which is a sign of systemic inflammation) (3).

Diagnosis of Acute Cholecystitis

Abdominal ultrasound is the imaging test choice to diagnose gallstones (4). A CT (computed tomography) imaging test may be requested for patients with high BMI or if the diagnosis is unclear.
In addition to imaging, the surgeon may also request biochemistry tests to look for systemic signs of inflammation and liver and pancreatic enzymes to exclude other complications of gallstones such as Acute Cholangitis and Acute Pancreatitis.

Treatment of Acute Cholecystitis

1. Antibiotics

Initial management includes treating with antibiotics (5). The patient may require hospital admission for intravenous antibiotics if inflammation is severe or is severely septic.

2. Surgery

Invasive:

The patient will be offered a cholecystectomy (removal of gallbladder) in the outpatient setting (as a planned procedure) or 24-72 hours of diagnosis if the patient is critically unwell because of Acute Cholecystitis.

Non-Invasive:

If the patient is not fit for any invasive surgical procedure, the surgeon will request a cholecystostomy (a minimally invasive procedure to drain gallbladder) (6).

Sources

Referenced on 27.4.2021

  1. Strasberg SM. Clinical practice. Acute calculous cholecystitis. N Engl J Med. 2008 Jun 26;358(26):2804-11
  2. Indar AA, Beckingham IJ. Acute cholecystitis. BMJ. 2002 Sep 21;325(7365):639-43
  3. Trowbridge RL, Rutkowski NK, Shojania KG. Does this patient have acute cholecystitis? JAMA. 2003 Jan 1;289(1):80-6
  4. Yokoe M, Hata J, Takada T, Strasberg SM, et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci. 2018 Jan;25(1):41-54
  5. Okamoto K, Suzuki K, Takada T, Strasberg SM, et al. Tokyo Guidelines 2018: flowchart for the management of acute cholecystitis. J Hepatobiliary Pancreat Sci. 2018 Jan;25(1):55-72
  6. Hamy A, Visset J, Likholatnikov D, Lerat F, Gibaud H, Savigny B, Paineau J. Percutaneous cholecystostomy for acute cholecystitis in critically ill patients. Surgery. 1997 Apr;121(4):398-401. doi: 10.1016/s0039-6060(97)90309-3. PMID: 9122869.
  7. 1. Rance C, Jones A. Gallstone disease. InnovAiT. 2016;9(1):11-17. doi:10.1177/1755738015576782

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