Sudden Inflammation of Gall Bladder

Acute cholecystitis is the acute bacterial inflammation of the gall bladder with or without stone. The typical victim is the fatty, fertile female in the age group of 40 – 50 years.

Types

Calculous obstructive cholecystitis – It is the commonest variety.

Acalculous non-obstructive cholecystitis – It is the uncommon variety, seen in patients who recover from head injury, burns, major surgery, diabetic patients, etc.

Gallstones induce chemical inflammation of the gall bladder wall, usually by obstruction of the cystic duct by a stone impacted in the Hartmann’s pouch.

Clinical Manifestations

There is sudden onset of severe upper quadrant pain radiating to epigastrium, back or shoulders.

As the condition develops further, the pain becomes duller and more localized followed by the onset of nausea, retching and then vomiting. Persistent vomiting suggests a bile duct stone.

The temperature rises and the pulse rate increases with the onset of the infection. With pain and rigor, jaundice also develops.

Lab Investigations

Total white blood count (WBC) is always raised with increased bilirubin in the liver function test (LFT).

Plain x-ray abdomen in the erect position finds out the gall stones. In emergency cases, ultrasound may also be performed to demonstrate gall stones or biliary sludge.

HIDA (Hepatic imino diacetic acid) scan is useful in case of acalculous cholecystitis.

Treatment

Treatment is usually conservative with hospitalization of the patient. Elective cholecystectomy (removal of gall bladder) is done after 6 weeks of broad spectrum antibiotics. In emergency cases, early cholecystectomy may also be performed.

Complications

These include mucocele or empyema of gall bladder, perforation, gall stone ileus or fall stone fistula. Inflammation followed by extensive ulcerations of gall bladder may result in perforation of the gall bladder with biliary peritonitis.

Complete obstruction of gall bladder leads to mucocele or pyocele (high grade fever and chills and rigor especially in diabetics leading to septicemia). Gangrene of the gall bladder occurs if the blood vessels get thrombosed.