Clinical Review

Acute cholecystitis

BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7365.639 (Published 21 September 2002) Cite this as: BMJ 2002;325:639
  1. Adrian A Indar, surgical fellow,
  2. Ian J Beckingham (Ian.Beckingham@nottingham.ac.uk), consultant hepatobiliary and laparoscopic surgeon
  1. Section of Gastrointestinal Surgery, University Hospital Nottingham, Nottingham NG7 2UH
  1. Correspondence to: I J Beckingham
  • Accepted 28 June 2002

Patients with suspected acute cholecystitis should be referred to hospital and, if the diagnosis is confirmed, early surgery is indicated

Acute cholecystitis—inflammation of the gall bladder—is most often caused by gall stones. Gall stones are one of the most common disorders of the gastrointestinal tract, affecting about 10% of people in Western society. 1 2 More than 80% of people with gall stones are asymptomatic. Acute cholecystitis develops in 1-3% of patients with symptomatic gall stones.3

Helminthic infection (ascariasis) is a major cause of biliary disease in developing countries in Asia, southern Africa, and Latin America.4 Obstruction of the cystic duct causes an inflammatory process to start. This results in acute cholecystitis. If the inflammation persists it may cause perforation or gangrene of the gall bladder.

Fig 1.

Pathogenesis of acute cholecystitis

Diagnosis of acute cholecystitis is made on the basis of clinical features and is supported by results of ultrasound scanning. Treatment is predominantly surgical, although the timing of surgery is under debate.

Summary points

Acute cholecystitis is most often caused by gall stones

Patients suspected of having acute cholecystitis should be referred to hospital immediately

First line treatments include fasting, intravenous fluids, and analgesia

Surgery (cholecystectomy) within 24-48 hours of admission (early) is preferable to delayed or “interval” surgery

Percutaneous cholecystostomy is a safe alternative to cholecystectomy for very ill patients or those unfit to undergo surgery

In 20% of cases, emergency surgery is needed to treat gangrenous cholecystitis or gallbladder perforation

Methods

We prepared this review by searching Medline for articles in English that included the term “acute cholecystitis.” We looked at clinical trials with clear end points and conclusions, and present findings of trials that reflect most of the work published.

Pathogenesis

Over 90% of cases of acute cholecystitis result from obstruction of the cystic duct by gall stones or …

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