Introduction
Acute cholecystitis describes inflammation of the gallbladder, typically secondary to gallstones.
Epidemiology
- Incidence: 140.00 cases per 100,000 person-years
- Peak incidence: 40-50 years
- Sex ratio: more common in females 3:1
| Condition | Relative incidence |
|---|---|
| Biliary colic | 7.14 |
| Acute cholecystitis | 1 |
| Acute appendicitis | 0.79 |
| Ascending cholangitis | 0.36 |
| Acute pancreatitis | 0.29 |
| Perforated peptic ulcer | 0.05 |
| Cholangiocarcinoma | 0.01 |
| <1 | 1-5 | 6+ | 16+ | 30+ | 40+ | 50+ | 60+ | 70+ | 80+ |
Clinical features
Features
- Right upper quadrant pain
- Fever and signs of systemic upset
- Murphy's sign on examination
- Occasionally mildly deranged LFT's (especially if Mirizzi syndrome)
Investigations
Investigation
- ultrasound is the first-line investigation of choice
- if the diagnosis remains unclear then cholescintigraphy (HIDA scan) may be used
- technetium-labeled HIDA (hepatobiliary iminodiacetic acid) is injected IV and taken up selectively by hepatocytes and excreted into bile
- in acute cholecystitis there is cystic duct obstruction (secondary to odema associated with inflammation or an obstructing stone) and hence the gallbladder will not be visualised
Management
Treatment
- intravenous antibiotics
- NICE now recommend early laparoscopic cholecystectomy, within 1 week of diagnosis. Previously, surgery was delayed for several weeks until the inflammation has subsided
Complications
Complications
- gangrenous cholecystitis
- occurs in up to 20% of patients
- perforation
- occurs in up to 10% of patients
- may result in either a pericholecystic abscess or peritonitis
- cholecystoenteric fistula
- usually seen with chronic cholecystitis
- results in air in the biliary tree (pneumobilia)
- if a gallstone passes through the fistula may result in gallstone ileus