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
- Adrian A Indar, surgical fellow,
- Ian J Beckingham (Ian.Beckingham@nottingham.ac.uk), consultant hepatobiliary and laparoscopic surgeon
- Section of Gastrointestinal Surgery, University Hospital Nottingham, Nottingham NG7 2UH
- Correspondence to: I J Beckingham
- Accepted 28 June 2002
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.
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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