Complications

The complications of acute cholecystitis include:

• empyema
• gangrenous cholecystitis
  • occurs in 2% to 30% of cases. Gangrene occurs most commonly at the fundus due to a compromised vascular supply (1).
• perforation of the gallbladder
  • in 3% to 10% of patients (after the gallbladder has perforated, patients may experience transient relief of their symptoms because the gallbladder decompresses, but peritonitis then develops) (1)
• emphysematous cholecystitis
  • caused by secondary infection of the gallbladder wall with gas-forming organism
  • common in elderly, and men with diabetes
  • requires immediate antibiotics (directed at anaerobes, coliforms, and Clostridia species) and urgent surgery due to high incidence of perforation (2)
• pancreatitis
• perihepatic abscess
• portal pyaemia and septicaemia

References:

1. Indar AA, Beckingham IJ. Acute cholecystitis. BMJ. 2002 Sep 21;325(7365):639-43.
2. Elwood DR. Cholecystitis. Surg Clin North Am. 2008;88(6):1241-52