Acute cholecystitis

Acute cholecystitis is nonspecific inflammation of gallbladder. By frequency this disease takes second place after acute appendicitis and makes about 10% in relation to all acute surgical diseases of abdominal cavity organs.

Acute cholecystitis occurs most commonly because of an obstruction of the cystic duct from cholelithiasis. Ninety percent of cases involve stones in the cystic duct (i.e., calculous cholecystitis), with the other 10% representing acalculous cholecystitis.

Acalculous acute cholecystitis is associated with biliary stasis, including debilitation, major surgery, severe trauma, sepsis, long-term total parenteral nutrition and prolonged fasting. Other causes of acalculous cholecystitis include cardiovascular attacks; sickle cell disease; Salmonella infections; diabetes mellitus; and cytomegalovirus, cryptosporidiosis or microsporidiosis infections in patients with AIDS.

Although bile cultures are positive for bacteria in 50–75% of cases, bacterial proliferation may be a result of cholecystitis and not the precipitating factor.

Risk factors for cholecystitis include increasing age, female sex, certain ethnic groups, obesity or rapid weight loss, drugs and pregnancy.

As a result inflammatory process develops from simple (catarrhal or superficial) cholecystitis till destructive cholecystitis (phlegmonous, gangrenous) and complicatedcholecystitis.

Classification. Acute cholecystitis is divided into:

I. Acute calculous cholecystitis.

II. Acute non-calculous cholecystitis:

1. Catarrhal.

2. Phlegmonous.

3. Gangrenous.

4. Complicated:

a) hydropsy;

b) empyema;

c) biliary pancreatitis;

d) choledocholithiasis;

e) hepatitis;

f) cholangitis;

g) mass;

h) abscess;

i) hepatorenal insufficiency;

j) peritonitis (local, general).