emphysematous cholecystitis

Acute Cholecystitis. The most frequent cause of acute cholecystitis is gallstones. Other causes include typhoid fever and a malignant tumor obstructing the biliary tract. The inflammation may be secondary to a systemic sepsis.

The symptoms of a mild inflammation may be very slight and include indigestion, moderate pain and tenderness in the upper right quadrant of the abdomen that is usually aggravated by deep breathing, malaise, and a low-grade fever. When gallstones or other disorders cause complete obstruction of the bile ducts, the symptoms are much more extreme. The pain becomes unbearable, the temperature may rise to 40°C (104°F), and there is nausea and vomiting.

Treatment of acute cholecystitis may entail either cholecystectomy or cholecystostomy. In some cases the surgery may be postponed until the attack subsides.

Chronic Cholecystitis. Chronic cholecystitis progresses more slowly than acute cholecystitis, but it also is usually the result of gallstones or other conditions that lead to obstruction of the bile ducts and impaired gallbladder function. It is the most common disorder of the gallbladder.

The characteristic symptom of chronic cholecystitis is indigestion manifested by discomfort after eating, with flatulence and nausea. If the meal has been larger than usual, or high in fat content, the symptoms are more pronounced and there is eructation (belching) and regurgitation. There may also be vomiting and some pain in the upper right quadrant of the abdomen. It is not unusual for patients to suffer repeated episodes before seeking medical attention. Neglect of the situation may lead to permanent damage to the gallbladder and liver.

Diagnosis of cholecystitis is aided by the use of ultrasonography to visualize an enlarged, inflamed gallbladder and detect the presence of gallstones. Radionuclide scanning is the most reliable diagnostic test for cholecystitis.

The preferred treatment of chronic cholecystitis with gallstones is cholecystectomy. If surgery is contraindicated for some reason, then the symptoms may be controlled to some extent by low-fat diet, restriction of alcohol intake, and spacing of meals so that large amounts of food are avoided and there is not a long interval between meals.