Major complication of cholelithiasis (i.e., gallstones); symptomatic gallstones are common before developing cholecystitis.
Patients typically present with pain and localised tenderness, with or without guarding, in the upper right quadrant.
There may be evidence of a systemic inflammatory response with fever, elevated white cell count, and raised C-reactive protein.
Ultrasound is the definitive initial test. Magnetic resonance cholangiopancreatography may be required. In a patient with suspected sepsis, use computed tomography (or magnetic resonance imaging)to identify the cause.
Treatment is withantibiotics, analgesia, and fluid resuscitation as required, likely to be followed by an early cholecystectomy.
Acute cholecystitis is acute gallbladder inflammation, and one of the major complications of cholelithiasis or gallstones. It develops in up to 10% of patients with symptomatic gallstones. In most cases (90%), it is caused by complete cystic duct obstruction usually due to an impacted gallstone in the gallbladder neck or cystic duct, which leads to inflammation within the gallbladder wall. In 5% of cases, bile inspissation (due to dehydration) or bile stasis (due to trauma or severe systemic illness) can block the cystic duct, causing an acalculous cholecystitis.
History and exam
General and Colorectal Surgeon
Queen's Medical Centre
JA is a member of the Council of the Royal College of Surgeons of England and Clinical Lead for General Surgery, Getting It Right First Time.
JA is a trustee and Council member of the Royal college of Surgeons of England
BMJ Best Practice would like to gratefully acknowledge the previous expert contributor, whose work has been retained in parts of the content:
Charles Bellows MD
Professor of Surgery
University of New Mexico School of Medicine
CB is an author of one study referenced in this topic. CB declares that he has no other competing interests.
Christian Macutkiewicz, MD, FHEA, FRCS
Consultant General and Hepato-Pancreato-Biliary Surgeon
Clinical Lead for Emergency General Surgery, Gastrointestinal Medicine, and Surgery CSU
Manchester Royal Infirmary
Director of Scientific Programme
Association of Surgeons of Great Britain and Ireland
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Section Editor, BMJ Best Practice
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