Acute cholecystitis is a major complication of cholelithiasis (i.e., gallstones); symptomatic gallstones are common before developing cholecystitis.
Right upper quadrant (RUQ) pain lasting more than 3 to 6 hours and fever are common.
RUQ tenderness, a distended RUQ mass, and positive Murphy sign are key examination findings.
Ultrasound is the initial test of choice; hepatobiliary iminodiacetic acid (HIDA) scanning and magnetic resonance imaging may be helpful in cases where diagnosis is unclear.
Treatment is early cholecystectomy.
Acute cholecystitis is acute inflammation of the gallbladder, and is one of the major complications of cholelithiasis (the presence of gallstones). In most cases (90%), acute cholecystitis is caused by obstruction of the cystic duct due to a stone 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 acalculous cholecystitis.
Bacterial infection can develop as a secondary feature; it is not an initiating event. Infection may be community- or healthcare-acquired. This topic covers community-acquired infection only.
History and exam
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.
Satyajit Bhattacharya, LVO, MB, MS, MPhil, FRCS
HPB Surgery Unit
The Royal London Hospital
SB declares that he has no competing interests.
Stefano Guandalini, MD
Professor of Pediatrics
Division of Gastroenterology, Hepatology, and Nutrition
University of Chicago Comer Children's Hospital
SG declares that he has no competing interests.
Use of this content is subject to our disclaimer