Cholecystitis is inflammation secondary to infection associated with stones within the gallbladder. It is not entirely clear how the infection rises but it probably comes via the blood stream. The typical symptoms are fairly persistent pain in the upper abdomen, particularly on the right side. This is quite severe in nature and tends to be constant. There is an associated constitutional upset in the form of fever, nausea and vomiting. Patients can be rendered really quite sick with cholecystitis and in most cases necessitates admission to hospital for intravenous fluid replacement, antibiotics, analgesia (pain relief) and rest. It usually takes several days for the infection and consequent inflammation to settle.
There are two alternatives with regards to the definitive management: either to perform an urgent cholecystectomy or to perform an interval procedure namely a delay of approximately six weeks allowing the inflammation to settle. The latter will almost always happen if allowed to do so and therefore an urgent laparoscopic cholecystectomy is really only indicated in patients that don’t settle as anticipated.
There are two unusual complications of cholecystitis; firstly abscess formation (empyema). This requires urgent drainage. The second is gangrene of the gallbladder wall resulting in perforation. Once again this requires urgent attention in the form of a cholecystectomy.