cholecystitis is seen in less than 10% of cholecystectomy specimens in
There is a female
preponderance with a mean age of 60 years.
Cystic duct obstruction is the most important event in the
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
Diagram showing gross appearance of
gallbladder in acute cholecystitis.
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
findings will vary a little according to severity and stage in
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
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
(2) geriatric biliary tract
(3) acalculous cholecystitis,
(4) acute and intrahepatic
cholangitis accompanying hepatolithiasis
(5) acute biliary tract infection
accompanying malignant pancreatic-biliary tumor,
(6) postoperative biliary tract
(7) acute biliary tract infection
accompanying congenital biliary dilatation and pancreaticobiliary
(8) primary sclerosing cholangitis.