- Gangrenous cholecystitis: severe pain, fever, hemodynamic instability
- Perforation: sudden relief of pain followed by peritonitis
- Emphysematous cholecystitis: gas in gallbladder wall (diabetics) – requires emergency surgery
Acute Cholecystitis
Must-Not-Miss / Red Flags
Patient Explanation
“A stone has blocked your gallbladder, causing it to become swollen and painful. We’ll treat the infection and likely remove the gallbladder with a small operation.”
Board Fact
“The most common sign on ultrasound is a thickened gallbladder wall >4 mm with pericholecystic fluid and sonographic Murphy’s sign.”
ICD-10
K81.0
Definition & Core Concept
Acute cholecystitis is an acute inflammation of the gallbladder, most commonly caused by gallstone obstruction of the cystic duct, leading to distension, ischemia, and secondary bacterial infection.
Epidemiology & Risk Factors
- Gallstones affect 10‑15% of adults; 1‑3% develop acute cholecystitis
- Female‑to‑male ratio 3:1 until age 50, then equal
- Risk factors: female, forty, fertile, fat (the “4 Fs”)
Clinical Vignette
A 50‑year‑old woman with obesity presents with 24 hours of severe RUQ pain after eating fried chicken. She has a fever of 38.5°C and a positive Murphy’s sign. Ultrasound shows a distended gallbladder with a 2‑cm stone in the neck.
Pearls & Pitfalls
- Acalculous cholecystitis occurs in critically ill patients (burns, TPN, prolonged fasting) – ultrasound may be normal; HIDA scan is diagnostic.
- Elderly patients may present with vague symptoms and no fever – maintain a high index of suspicion.
Discharge & Follow-Up
Post‑operative: advance diet as tolerated, activity restrictions for 2 weeks, office visit in 10‑14 days for wound check.
Literature & Guidelines
WSES Guidelines on acute calculous cholecystitis (2024). PMID: 38566101.