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Gallbladder Pathology Online

Pathology of Acute Cholecystitis 

Dr Sampurna Roy  MD  


Acute cholecystitis is seen in less than 10% of cholecystectomy specimens in most centres.

There is a female preponderance with a mean age of 60 years.

Cystic duct obstruction is the most important event in the etiology.

It is more common to find a solitary stone obstructing Hartmannís pouch than in chronic cholecystitis where multiple stones are usually found.

Acute cholecystitis also has other causes, such as ischemia, chemicals that enter biliary secretions, motility disorders associated with drugs, infections with microorganisms, protozoa, and parasites, collagen disease and allergic reactions.  Infectious Disease Online

The role of bacteria is controversial in the etiology of acute cholecystitis.


Diagram showing gross appearance of gallbladder in acute cholecystitis.

Grossly, the gallbladder is enlarged and firm, with a thickened wall. There is oozing of serous or serosanguineous fluid. There is prominent edema and outer surface is a dusky reddish brown. The mucosa is congested and grayish red. The mucosa is intact or can be replaced by necrotic slough when acute cholecystitis is severe.

Microscopic image of acute cholecystitis.

The histological findings will vary a little according to severity and stage in evolution.

Early in the disease, marked edema is the main feature with fibrin extravasation and hemorrhage being seen in some cases.

Mucosal ulceration and necrosis may be present depending on the severity.

The neutrophilic infiltrate is most prominent at 3-5 days. Fibroblasts are prominent by day ten.

Occasionally, there may be vasculitis with fibrinoid necrosis of the muscular arteries. Some of these patients may go to full-blown multisystem disorders, in others vasculitis-like changes are confined to gallbladder.

Pre-existing chronic cholecystitis may also be present.



Risk factors for complications:  Elderly male ; presence of associated disease ; high temperature ; and leukocytosis.

Free perforation into the peritoneal cavity has become a rare complication. However, in an acutely distended gallbladder, bile may leak throught the intact wall and cause bile peritonitis.

Hemorrhagic infarction of the gallbladder (gangrenous cholecystitis) may occur from an impacted stone that interferes with the venous drainage of gallbladder.

The overall mortality is 4%. This is improved by early cholecystectomy.

Note:  Unusual cases of acute cholecystitis and cholangitis include:

(1) pediatric biliary tract infections,

(2) geriatric biliary tract infections,

(3) acalculous cholecystitis,

(4) acute and intrahepatic cholangitis accompanying hepatolithiasis

(5) acute biliary tract infection accompanying malignant pancreatic-biliary tumor,

(6) postoperative biliary tract infection,

(7) acute biliary tract infection accompanying congenital biliary dilatation and pancreaticobiliary maljunction, and

(8) primary sclerosing cholangitis.


Further reading:

Unusual cases of acute cholecystitis and cholangitis

Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis.

Endoscopic gallbladder drainage of patients with acute cholecystitis

Acute cholecystitis complicating cardiac surgery

Factors effecting the complications in the natural history of acute cholecystitis

Acute cholecystitis: an evaluation of the factors that determine the start of surgical treatment

Acute cholecystitis in the intensive care unit.

Acute cholecystitis in a traumatologic patient sample

Acute cholecystitis.



Dr  Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)










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