Acute Cholecystitis

Acute cholecystitis is sudden inflammation of the gallbladder that causes severe pain in the upper right part of your abdomen and requires immediate medical attention to prevent serious complications.

Table of contents

• What is acute cholecystitis?
• What causes acute cholecystitis?
• Symptoms of acute cholecystitis
• How is acute cholecystitis diagnosed?
• Treatment options
• Possible complications

What is acute cholecystitis?

• Gallbladder
• Liver
• Cystic duct
• Bile ducts

Acute cholecystitis is sudden swelling and inflammation of the gallbladder, a small pear-shaped organ located under your liver on the right side of your abdomen. The gallbladder stores bile, a green-yellow fluid produced by your liver that helps digest fats in your food.^[1][2]

Your gallbladder sends bile to your small intestine through tiny pipelines called bile ducts. When something blocks these ducts or the opening to your gallbladder, bile can build up inside, causing pressure, swelling, and inflammation. This blockage can also encourage infections to develop inside the gallbladder.^[4][6]

Acute cholecystitis is a major complication of having gallstones and is considered a potentially life-threatening condition that requires prompt medical care. About 15% of the world’s population has gallstones, and approximately 20% of people with gallstones will develop complications like cholecystitis.^[6]

What causes acute cholecystitis?

The most common cause of acute cholecystitis is gallstones blocking your bile ducts. Gallstones are small, hard pieces usually made of cholesterol that form in the gallbladder. They can travel and sometimes get stuck in the cystic duct (the main opening of the gallbladder) or in other bile ducts.^[3][4]

When a gallstone blocks the cystic duct, bile cannot flow out of the gallbladder normally. This causes bile to build up, which increases pressure inside the gallbladder and leads to inflammation. The damaged gallbladder wall can then become infected by bacteria, making the condition worse.^[7][15]

About 90 to 95% of acute cholecystitis cases involve gallstones. This type is called calculous cholecystitis.^[3][5]

In 5 to 10% of cases, acute cholecystitis can occur without gallstones. This less common form is called acalculous cholecystitis and is usually more serious. It typically happens as a complication of severe illness, major surgery, serious injuries or burns, blood poisoning, severe malnutrition, or prolonged fasting. People who are critically ill or receiving nutrition through a vein for extended periods are at higher risk.^[7][15]

Several factors increase your risk of developing gallstones and acute cholecystitis. These include being female, pregnancy, hormone therapy, older age, obesity, rapid weight loss or gain, and diabetes.^[4]

Symptoms of acute cholecystitis

The main symptom of acute cholecystitis is sudden, sharp pain in the upper right side or center of your abdomen. This pain typically builds quickly to a peak and lasts longer than a few hours, often persisting for more than six hours.^[2][3]

The pain may spread toward your right shoulder blade or upper back. The affected part of your abdomen is usually very tender to touch, and breathing deeply can make the pain worse. Unlike other types of stomach pain, the pain from acute cholecystitis does not come and go—it stays constant.^[3][15]

Additional symptoms commonly include:^[2][3][4]

• Nausea and vomiting
• Fever—usually low grade but may reach over 100 degrees Fahrenheit (38 degrees Celsius)
• Sweating
• Loss of appetite
• Bloating or swelling in the abdomen
• Yellowing of the skin and whites of the eyes (jaundice)
• A bulge or mass that can be felt in the abdomen

In older people, symptoms may be milder and less specific. They might only experience vague discomfort, loss of appetite, weakness, or a general sense of feeling unwell. Fever is also less common in older adults.^[6][15]

If you develop sudden and severe abdominal pain that lasts longer than a few hours, especially if accompanied by fever or jaundice, seek medical attention immediately. If the pain is so severe that you cannot get comfortable, go straight to your nearest hospital emergency department.^[3][4]

How is acute cholecystitis diagnosed?

If you have symptoms suggesting acute cholecystitis, your doctor will perform a physical examination and ask about your symptoms and medical history. During the physical exam, your doctor may perform a test called Murphy’s sign. You will be asked to breathe in deeply while the doctor’s hand is pressed on your abdomen below your rib cage. If you have cholecystitis, you will feel sudden, sharp pain as your gallbladder moves downward and reaches the doctor’s hand.^[3][8]

If acute cholecystitis is suspected, you will typically be referred to a hospital immediately for further tests and treatment. Tests commonly used to diagnose acute cholecystitis include:^[3][4][8]

• Blood tests to check for signs of inflammation and infection in your body
• Abdominal ultrasound, which is usually the first imaging test performed. It can detect gallstones and show signs of inflammation in the gallbladder
• HIDA scan (hepatobiliary iminodiacetic acid scan), which tracks the flow of bile through your body and can show blockages in the bile ducts
• CT scan (computed tomography) or MRI (magnetic resonance imaging) of the abdomen to get more detailed pictures of your gallbladder and surrounding organs

These imaging tests can reveal gallstones, thickening of the gallbladder wall, fluid around the gallbladder, and other signs of cholecystitis.^[8][5]

Treatment options

Acute cholecystitis requires hospital treatment because of the risk of serious complications. Treatment typically involves both immediate medical care and surgical intervention.^[3][11]

Initial medical treatment

When you are first admitted to the hospital, initial treatment usually includes:^[3][4][10]

• Not eating or drinking (fasting) to reduce strain on your gallbladder
• Receiving fluids through a drip directly into a vein to prevent dehydration
• Taking pain relief medication
• Receiving antibiotics through a vein to fight infection

These treatments help stabilize your condition and control infection. Antibiotics are given to cover common bacteria associated with cholecystitis, including certain types of intestinal bacteria. You may need to continue antibiotics for up to a week.^[10][11]

Surgical treatment

The preferred treatment for most people with acute cholecystitis is surgery to remove the gallbladder, called cholecystectomy. This prevents the condition from coming back and reduces your risk of developing serious complications.^[3][8]

The best time to perform surgery is usually within 72 hours of diagnosis, though it may be done up to 7 to 10 days after symptoms begin. Early surgery has been shown to improve outcomes and help patients recover faster.^[11][1]

Most cholecystectomies are done using laparoscopic surgery, a minimally invasive technique. Small incisions are made in the abdomen, and special surgical tools along with a tiny video camera are used to remove the gallbladder. This approach typically results in less pain, shorter hospital stays, and faster recovery compared to traditional open surgery.^[8]

In some cases, traditional open surgery may be needed, especially if complications have developed or if laparoscopic surgery is not suitable for your situation.^[8]

Alternative treatments for high-risk patients

For patients who are too ill or have conditions that make surgery too risky, alternative treatments may be considered. These include:^[11][1]

• Percutaneous cholecystostomy, where a drainage tube is placed through the skin into the gallbladder to drain bile and reduce inflammation
• Endoscopic drainage, where a tube is inserted through the mouth to drain the gallbladder
• Conservative management with antibiotics alone, though surgery is typically recommended later when the patient is more stable

If surgery is delayed, it is usually recommended to wait at least six weeks after the initial episode before performing the operation.^[3]

Possible complications

Without prompt treatment, acute cholecystitis can lead to serious complications. Approximately 10% of untreated patients may develop severe problems.^[15]

Potential complications include:^[4][7][15]

• Gangrene, where tissue in the gallbladder dies due to lack of blood flow
• Perforation, where a hole forms in the gallbladder wall, allowing infected bile to leak into the abdomen
• Empyema, where pus fills the gallbladder
• Peritonitis, a serious infection of the lining of the abdomen
• Pancreatitis, inflammation of the pancreas
• Common bile duct obstruction, which can cause jaundice

A perforated gallbladder is particularly dangerous, with mortality rates up to 16%. Signs that complications may be developing include increasing abdominal pain, high fever, rigors (severe shaking chills), and worsening tenderness when the abdomen is touched.^[15]

Most people who have surgery to remove their gallbladder recover completely. You can live a normal, healthy life without a gallbladder because bile will flow directly from your liver to your small intestine.^[4]