Causes and Risks:

In 90% of cases, acute cholecystitis is caused by gallstones in the gallbladder which obstruct the duct leading from the gallbladder to the common bile duct. Severe illness, and rarely, tumors of the gallbladder can also cause cholecystitis.

The trapped bile becomes concentrated and causes irritation and pressure build-up in the gallbladder. This can lead to bacterial infection and perforation. The attack may follow a large or fatty meal.

Gallstones occur more frequently in women than men, and the incidence increases with age in both sexes. Native Americans have a higher incidence of gallstones. The incidence is 2 out of 10,000 people.

Prevention:

Treatment (removal) of gallstones may prevent further attacks of cholecystitis. Reduce fat in the diet if prone to attacks of cholecystitis.

Signs and Tests:

Examination of the abdomen by touch (palpation) reveals tenderness.

Tests that detect the presence of gallstones or inflammation include:

• abdominal ultrasound
• abdominal CT scan
• abdominal X-ray
• oral cholecystogram
• gall bladder radionuclide scan
• A CBC shows infection by an elevated white blood cell count.

Treatment:

Although cholecystitis may resolve spontaneously, surgery to remove the gallbladder (cholecystectomy) is indicated because inflammation frequently persists or recurs. This operation is performed as soon as possible after the onset of cholecystitis, unless the patient is very ill, or if the inflammation is thought to have been present for many days.

Occasionally, in very ill patients, a tube can be placed through the skin "percutaneously" to drain the gallbladder until the patient recovers from the acute illness and is fit to undergo surgery. This is called a cholecystostomy tube".

The operation performed to remove the gall bladder is called cholecystectomy. This operation is performed laparoscopically in most cases. In a laparoscopic cholecystectomy, small (1 cm) incisions are made in the abdomen, through which are passed instruments and a fiberoptic camera.

The operation is performed using these small instruments while the surgeon watches the image on a video monitor. Laparoscopic cholecystectomy results in less pain and shorter hospitalization times than the open operation. If there is a significant amount of inflammation, or there is difficulty defining the anatomy, or if significant bleeding occurs, a laparoscopic operation may need to be converted to an open operation, performed through a larger incision.

Emergency surgery is done when gangrene (tissue death), perforation, pancreatitis, or inflammation of the common bile duct occurs.

Non-surgical treatment consists of pain control, antibiotics to eliminate the infection, and a low fat diet when food is tolerated after the acute attack.

Prognosis:

With cholecystectomy, the outcome for cholecystitis is very good.

Complications:

• empyema (pus in the gallbladder)
• peritonitis (inflammation of the lining of the abdomen)
• gangrene (tissue death) of the gallbladder

Injury to the bile ducts draining the liver is a rare complication of cholecystectomy.

Call your health care provider if severe abdominal pain persists.

Call for an appointment with your health care provider if symptoms of cholecystitis recur after an acute episode.