Acute cholecystitis

Acute cholecystitis is an acute inflammation of the gallbladder.

• 90% of cases are associated with impacted gallstones or biliary sludge at the neck of the gall bladder or cystic duct; ‘acute calculous cholecystitis’ (1).
• Remaining 5–10% are not associated with gallstones and is known as ‘acalculous cholecystitis’.

Obstruction of the gallbladder neck or cystic duct by a gallstone results in increased pressure in the gallbladder. The degree of obstruction and the duration of the obstruction determine the progression to acute cholecystitis:

• partial and of short duration obstruction results in biliary colic
• prolonged, complete obstruction over many hours leads to acute cholecystitis (2)

Inflammation is initially sterile in most cases but secondary infection with enteric organisms (Escherichia coli, Klebsiella, and Streptococcus faecalis) may complicate the clinical course in up to 50% of patients (primary infection is not believed to play an initial role in cholecystitis) (1,3).

Overall, there are more female patients with acute cholecystitis due to the high incidence of gallstones in females:

• however, acute cholecystitis develops in men more frequently when compared to the relative prevalence of gallstones (about half that in women)
• cholecystitis tends to be more severe in men
• develops more frequently in diabetic patients with symptomatic gallstones than in people without diabetes and also are more likely to have complications of acute cholecystitis when it occurs (1)

Acute cholecystitis is as a surgical emergency that must be distinguished from acute biliary colic.

References:

1. Strasberg SM. Clinical practice. Acute calculous cholecystitis. N Engl J Med. 2008;358(26):2804-11.
2. Kimura Y et al. TG13 current terminology, etiology, and epidemiology of acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci. 2013;20(1):8-23
3. Elwood DR. Cholecystitis. Surg Clin North Am. 2008;88(6):1241-52