Acute cholecystitis natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dildar Hussain, MBBS [2]
Overview
Acute Cholecystitis most commonly occurs as a result of the prolonged obstruction of the cystic duct leading to inflammation of the gallbladder. The obstruction further contributes to the development of the complications associated with acute cholecystitis such as gangrene, empyema, perforation, cholecystoenteric fistula, emphysematous cholecystitis, and gallstone ileus. Prognosis is generally good if the patient receives treatment. The majority of the patients undergo cholecystectomy.
Natural History, Complications, and Prognosis
Natural History
- The symptoms of acute cholecystitis usually develop after the obstruction of a gallstone in the bile duct over for over 7 to 10 days in calculus cholecystitis. Female sex, obesity, oral contraceptions, and an underlying disease of diabetes are associated with the development of acute cholecystitis. Acute cholecystitis presents with the symptoms such as right upper quadrant abdominal pain (biliary colic), nausea and vomiting.[1][2]
- If left untreated acute cholecystitis further leads to the development of gangrene, empyema, perforation, cholecystoenteric fistula, emphysematous cholecystitis and gallstone ileus.
Complications
Common complications of acute cholecystitis include:[3][4][5][6][7][8]
| Complication | Explanation |
|---|---|
| Gangrene | Gangrene of Gall Bladder is the most common complication of acute cholecystitis, if left untreated and in elderly patients with an underlying disease of diabetes. |
| Empyema | Prolonged untreated Acute cholecystitis worsens the inflammation of the gall bladder leading to collection of pus around the gall bladder called the empyema of gallbladder. |
| Perforation | Perforation of the Gall Bladder results due to gangrene of the gall bladder and leads to pericholecystic abscess.Peritonitis may also occur as a result of gall bladder perforation,such patients develop septicemia and have a high mortality rate. |
| Cholecystoenteric fistula | The Cholecystoenteric fistula usually occurs due to the perforation of the gall bladder associated with the long standing pressure necrosis due to gall stones than acute cholecystitis. |
| Emphysematous cholecystitis | It is associated with secondary infection of the gall bladder wall with gas forming organisms i.e Clostridium welchii,other organisms which can be found are Escherichia coli staphylococci,streptococci,Pseudomonas and Klebsiella. |
| Gallstone Illeus | Gallstone ileus is associated with the passage of gall stone through the cholecystoenteric fistula leading to mechanical obstruction of bowel in the terminal ileum. |
Prognosis
- Prognosis is generally good.Patients usually undergo interval cholecystectomy once acute cholecystitis develops,and prophylactic cholecystectomy if the patients develop symptoms of cholelithiasis The timing of when to conduct the cholecystectomy is still debatable.[9][10]
References
- ↑ Ruhl CE, Everhart JE (2000). "Association of diabetes, serum insulin, and C-peptide with gallbladder disease". Hepatology. 31 (2): 299–303. doi:10.1002/hep.510310206. PMID 10655249.
- ↑ Tsai CJ, Leitzmann MF, Willett WC, Giovannucci EL (2006). "Central adiposity, regional fat distribution, and the risk of cholecystectomy in women". Gut. 55 (5): 708–14. doi:10.1136/gut.2005.076133. PMC 1856127. PMID 16478796.
- ↑ BYRNE JJ, BERGER RL (1960). "The pathogenesis of acute cholecystitis". Arch Surg. 81: 812–6. PMID 13689586.
- ↑ Reiss R, Nudelman I, Gutman C, Deutsch AA (1990). "Changing trends in surgery for acute cholecystitis". World J Surg. 14 (5): 567–70, discussion 570–1. PMID 2238655.
- ↑ Roslyn JJ, Thompson JE, Darvin H, DenBesten L (1987). "Risk factors for gallbladder perforation". Am. J. Gastroenterol. 82 (7): 636–40. PMID 3605024.
- ↑ Lorenz RW, Steffen HM (1990). "Emphysematous cholecystitis: diagnostic problems and differential diagnosis of gallbladder gas accumulations". Hepatogastroenterology. 37 Suppl 2: 103–6. PMID 2083919.
- ↑ Clavien PA, Richon J, Burgan S, Rohner A (1990). "Gallstone ileus". Br J Surg. 77 (7): 737–42. PMID 2200556.
- ↑ Chawla A, Bosco JI, Lim TC, Srinivasan S, Teh HS, Shenoy JN (2015). "Imaging of acute cholecystitis and cholecystitis-associated complications in the emergency setting". Singapore Med J. 56 (8): 438–43, quiz 444. doi:10.11622/smedj.2015120. PMC 4545132. PMID 26311909.
- ↑ Gurusamy KS, Koti R, Fusai G, Davidson BR (2013). "Early versus delayed laparoscopic cholecystectomy for uncomplicated biliary colic". Cochrane Database Syst Rev (6): CD007196. doi:10.1002/14651858.CD007196.pub3. PMID 23813478.
- ↑ Gu MG, Kim TN, Song J, Nam YJ, Lee JY, Park JS (2014). "Risk factors and therapeutic outcomes of acute acalculous cholecystitis". Digestion. 90 (2): 75–80. doi:10.1159/000362444. PMID 25196261.