Acute cholecystitis is a sudden inflammation of the gallbladder that causes severe abdominal pain.
See also: Chronic cholecystitis
In 90% of cases, acute cholecystitis is caused by gallstones in the gallbladder. Other causes include severe illness and (rarely) tumors of the gallbladder.
Acute cholecystitis occurs when bile becomes trapped in the gallbladder. The buildup of bile causes irritation and pressure in the gallbladder. This can lead to infection and a hole (perforation) in the organ.
Gallstones occur more often in women than men. Gallstones become more common with age in both sexes. Native Americans and Hispanics have a higher rate of gallstones than most other people.
The main symptom is pain in the upper right side or upper middle of the abdomen. The pain may:
Other symptoms that may occur include:
A physical exam will show that your abdomen is tender to the touch.
Your doctor may order the following blood tests:
Imaging tests that can show gallstones or inflammation include:
Seek immediate medical attention for severe abdominal pain.
In the emergency room, patients with acute cholecystitis are given fluids through a vein and antibiotics to fight infection.
Although cholecystitis may clear up on its own, surgery to remove the gallbladder (cholecystectomy) is usually needed when gallstones are present. Surgery may be done as soon as possible; however, some patients will not need surgery right away.
Nonsurgical treatment includes:
You may need emergency surgery if you have gangrene (tissue death), perforation, pancreatitis, or inflammation of the common bile duct.
In very ill patients, a tube may be placed through the skin to drain the gallbladder until the patient gets better and can have surgery.
See also: Gallstones - discharge
Patients who have surgery to remove the gallbladder usually do very well.
Call your health care provider if:
Removing the gallbladder and gallstones will prevent further attacks.
Cholecystitis - acute
Siddiqui T. Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a meta-analysis of randomized clinical trials. Am J Surg. 2008;195:40-47.
Chari RS, Shah SA. Biliary system. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. St. Louis, Mo: WB Saunders; 2008:chap. 54.
Wang DQH, Afdhal NH. Gallstone disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 65.
Glasgow RE, Mulvihill SJ. Treatment of gallstone disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 66.
Updated by: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; and George F Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program San Diego, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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