Chronic cholecystitis natural history, complications and prognosis
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Furqan M M. M.B.B.S[2]
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Overview
Cholecystitis presents with abdominal pain, which is not relieved by antacids and postural changes and lasts longer than 6 hours. It is sometimes preceded by attacks of biliary pain (due to gallstones). Untreated cholecystitis resolves spontaneously in half of the uncomplicated cases without surgery in a span of 7 - 10 days. The complications of chronic cholecystitis include gangrenous cholecystitis, perforation of the gallbladder, Mirizzi syndrome, gallstone ileus, and gallbladder malignancies.
Natural History
The natural history of chronic cholecystitis is as under:
- Cholecystitis presents with abdominal pain, which is not relieved by antacids and postural changes and lasts longer than 6 hours.
- It is sometimes preceded by attacks of biliary pain (due to gallstones).
- Fever may not be a prominent symptom at the time of presentation but can be seen if untreated or complicated by infections.
- Untreated cholecystitis resolves spontaneously in half of the uncomplicated cases without surgery in a span of 7 - 10 days.
- The remaining cases can progress to complications and cause severe morbidity and mortality.[1]
Complications
The complications of chronic cholecystitis include:
Mirizzi syndrome
Mirizzi syndrome is due to the partial obstruction of the common hepatic bile duct. This can be secondary to stone impaction or chronic inflammation in the adjacent gallbladder Hartman pouch.[1]
Gangrenous cholecystitis
- Gangrenous cholecystitis may occur following severe inflammation that interrupts the blood flow to the gallbladder. It is potentially more life-threatening because the dead tissues are vulnerable to secondary severe infections, which can spread to become sepsis.[2][3]
- The known risk factors are:
- Male gender
- Age above 50 years
- Leukocytosis
- Diabetes
- Cardiovascular diseases
- The known risk factors are:
- CT scan is a better tool in the evaluation of gangrenous cholecystitis. The mortality rate of gangrenous cholecystitis is as high as 22% since it can lead to gallbladder perforation, abscess formation and peritonitis. So once suspected, an emergency cholecystectomy is done to reduce the morbidity and mortality due to its life threatening complications[4].
Gallbladder perforation
Gallbladder perforation (GBP) is a rare but life-threatening complication of cholecystitis. The early diagnosis and treatment of GBP are crucial to patient morbidity and mortality.[2][3][5][6]
Gallstone ileus
Gallstone ileus is the result of mechanical obstruction of the small bowel due to the gallstones. Gallstones reach the bowel through a fistulous channel between gallbladder and the small intestine.[1][6]
Malignancy
- The following growths may arise in chronic gallbladder infection:[3][6]
- Benign
- Malignant
- Adenocarcinoma
- Papillary carcinoma
- Squamous cell carcinoma
Prognosis
Uncomplicated cholecystitis has a favorable prognosis. Complicated cases can be treated successfully with surgery and they usually do well.[7]
References
- ↑ 1.0 1.1 1.2 Elwood DR (2008). "Cholecystitis". Surg. Clin. North Am. 88 (6): 1241–52, viii. doi:10.1016/j.suc.2008.07.008. PMID 18992593.
- ↑ 2.0 2.1 Bennett, GL.; Rusinek, H.; Lisi, V.; Israel, GM.; Krinsky, GA.; Slywotzky, CM.; Megibow, A. (2002). "CT findings in acute gangrenous cholecystitis". AJR Am J Roentgenol. 178 (2): 275–81. doi:10.2214/ajr.178.2.1780275. PMID 11804880. Unknown parameter
|month=ignored (help) - ↑ 3.0 3.1 3.2 "core.ac.uk" (PDF).
- ↑ Grant, RL.; Tie, ML. (2002). "False negative biliary scintigraphy in gangrenous cholecystitis". Australas Radiol. 46 (1): 73–5. PMID 11966592. Unknown parameter
|month=ignored (help) - ↑ Derici H, Kara C, Bozdag AD, Nazli O, Tansug T, Akca E (2006). "Diagnosis and treatment of gallbladder perforation". World J. Gastroenterol. 12 (48): 7832–6. PMID 17203529.
- ↑ 6.0 6.1 6.2 "Cross-Sectional Imaging of Acute and Chronic Gallbladder Inflammatory Disease : American Journal of Roentgenology : Vol. 192, No. 1 (AJR)".
- ↑ "Acute cholecystitis: MedlinePlus Medical Encyclopedia". Retrieved 2012-08-20.