Chronic cholecystitis natural history, complications and prognosis
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
Natural History
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 gall stones). 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.
Complications
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.[1][2]
- 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[3].
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.[1][2][4]
Major Complications of cholecystectomy
The major complications associated with the cholecystectomy are:[5]
- Abscess
- Ascending cholangitis
- Bile duct injury (about 5-7 out of 1000 operations. Open and laparoscopic surgeries have essentially equal injuries, but the recent trend is towards fewer injuries with laparoscopy, probably because the open cases often result because the gallbladder is too difficult or risky to remove with laparoscopy)
- Bile leak ("biloma")
- Bleeding (liver surface and cystic artery most common sites)
- Deep vein thrombosis/pulmonary embolism (unusual- risk can be decreased through use of sequential compression devices on legs during surgery)
- Hernia
- Organ injury (intestine and liver at highest risk, especially if gallbladder through inflammation has become adherent/scarred to other organs (e.g. transverse colon)
- Pancreatitis
- Perforation or rupture
- Wound infection
Prognosis
Uncomplicated cholecystitis has a favorable prognosis. Complicated cases can be treated successfully with surgery and they usually do well.[6]
References
- ↑ 1.0 1.1 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) - ↑ 2.0 2.1 "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.
- ↑ "www.ncbi.nlm.nih.gov" (PDF). Retrieved 2012-08-20.
- ↑ "Acute cholecystitis: MedlinePlus Medical Encyclopedia". Retrieved 2012-08-20.