Acute Cholecystitis

What is acute cholecystitis? 

Acute cholecystitis is inflammation of the gallbladder. The gallbladder is a small organ underneath the liver on the right side of the upper abdomen. The gallbladder’s job is to store bile and release it to the small bowel (duodenum) after a meal. Cholecystitis occurs when bile gets trapped in the gallbladder, commonly due to blockage from gallstones. When bile builds up, it can become infected with bacteria. Less common causes of blockage include tumours or benign strictures. 

What are gallstones 

Gallstones are are hardened deposits that can form in the gallbladder. They come in varied sizes and are made up of either cholesterol or pigment stones. The stones are not necessarily a problem. Its possible to have gallstones in the gallbladder, yet not develop any symptoms from it. In this case, the stones do not need to be treated. However, when the stones block the gallbladder or the tubes (ducts) that carry digestive fluids from the gallbladder to the small bowel (duodenum), the walls of the gallbladder or ducts may become inflamed with subsequent bacterial infection. Prompt presentation to a surgeon for treatment is warranted. 

Risks of developing gallstones 

• Family history of gallstones 

• Female above 50 years of age

• Excessive fat consumption

• Obesity / overweight 

• Pregnancy 

• Recent rapid weight loss 

Symptoms of acute cholecystitis 

Typically presents with sudden severe onset of right upper abdomen pain 15-20 minutes after eating and it continues. Pain may radiate to your right back or shoulder blade. Other associated signs and symptoms may include nausea, vomiting, fever, shakes and jaundice.

How is cholecystitis treated?

Treatment of cholecystitis usually takes place in the hospital  

The appropriate treatment will be determine by your surgeon and may include: 

• If the duration of symptoms is short, surgical removal of the gallbladder during the same admission is usually indicated. Surgery is usually performed with a keyhole approach, aiming to remove the gallbladder +/- perform a contrast test to check for presence of choledocholithiasis (stones in bile ducts), abnormal anatomy, and assist with the identification of ductal injury. Fasting, IV rehydration, pain medications, antibiotics are all important parts of treatment preoperatively. 

• If the duration of symptoms is longer than 5-7 days, conservative management with IV fluids and antibiotics followed by an elective removal of the gallbladder may be required. 

• Percutaneous drainage of the gallbladder is usually reserved for patients who are too ill to undergo surgery. This is performed by an interventional radiologist. 

• For patients with evidence of stones within the common bile duct, an Endoscopic retrograde cholangiopancreatography (ERCP) may be required for stone removal. After which, patient would usually proceed to removal of their gall bladder to prevent future stone spillage into the ducts.