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]


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


Common complications of acute cholecystitis include:[3][4][5][6][7][8]

Complication Explanation
Gangrene Gangrene of gallbladder 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 gallbladder leading to the collection of pus around the gallbladder called the empyema of the gallbladder.
Perforation Perforation of the gallbladder is a result of the gangrene of the gallbladder and lead to the pericholecystic abscess. Peritonitis may also occur as a result of gallbladder perforation, such patients develop septicemia and have a high mortality rate.
Cholecystoenteric fistula The cholecystoenteric fistula usually occurs due to the perforation of the gallbladder associated with the long-standing pressure necrosis due to gallstones 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.



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  2. 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.
  3. BYRNE JJ, BERGER RL (1960). "The pathogenesis of acute cholecystitis". Arch Surg. 81: 812–6. PMID 13689586.
  4. 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.
  5. Roslyn JJ, Thompson JE, Darvin H, DenBesten L (1987). "Risk factors for gallbladder perforation". Am. J. Gastroenterol. 82 (7): 636–40. PMID 3605024.
  6. Lorenz RW, Steffen HM (1990). "Emphysematous cholecystitis: diagnostic problems and differential diagnosis of gallbladder gas accumulations". Hepatogastroenterology. 37 Suppl 2: 103–6. PMID 2083919.
  7. Clavien PA, Richon J, Burgan S, Rohner A (1990). "Gallstone ileus". Br J Surg. 77 (7): 737–42. PMID 2200556.
  8. 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.
  9. 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.
  10. 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.

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