Definition
• 90% of acute cholecystitis cases are due to stones.
It occurs as a result of stone obstruction of the cystic duct and secondary infection.
The most common causative agent is E. coli.
• Stoneless cholecystitis, sometimes due to vasculitis, ischemia, direct infection of the gallbladder
it could be. Diabetes increases the risk of stoneless cholecystitis.
Clinic
• Symptoms of infection may be seen with right upper quadrant pain, nausea and vomiting.
• The increase in pain with palpation and cessation of inspiration (Murphy sign) in deep inspiration are the most valuable FM findings.
• Laboratory findings may include leukocytosis, increase in acute phase reactants, mild bilirubin and ALP elevation.
• Acute cholecystitis attack regresses within 1-2 days in uncomplicated cases.
Diagnosis
• Ultrasonography is the most practical and frequently used method in the diagnosis of acute cholecystitis and should be the first test of choice.
USG; It shows signs of hydrops/enlargement of the sac, edema, thickening and inflammation in the sac wall.
• Cholescintigraphy-HIDA (Tc 99m iminodiacetic acid) is more sensitive and reliable than USG in the diagnosis of acute cholecystitis, but it is not preferred because it is not practical and cannot be applied in every center.
Treatment
• Patients are hospitalized and their oral intake is stopped. IV fluids and antibiotics are started.
• Surgery is applied to cases whose clinical condition does not regress within 24-36 hours or if complications such as empyema, gangrene, perforation are considered.
Emphysematous cholecystitis
• It is a severe cholecystitis that develops especially in diabetic patients due to Clostridium welchii (or perfringes).
The presence of gas in the gallbladder wall in imaging methods is diagnostic.
• Its treatment is antibiotics+surgery.
Complications of cholecystitis
• Empyema, hydrops, gangrene, perforation, fistula, porcelain sac, gallstone ileus (passing of the stone into the intestine with cholecystocolic fistula and forming ileus) may be seen.
• Diagnosis of ileus is made by observing the air in the biliary tract and the air-fluid level in the intestine (on direct X-ray} together with the stone.