You may have chronic cholecystitis without any symptoms or you may experience recurrent right upper abdominal pain . The presence of nausea and fever suggest acute rather than chronic cholecystitis .
Diagnosis of chronic cholecystitis can be made by ultrasound, which usually reveals (Picture 1) :
- A shrunken gallbladder with a thick wall
- One or more gallstones
Picture 1. An ultrasound image of chronic cholecystitis
Lower arrow: a gallstone; Upper arrow: thick gallbladder wall
(source: Ultrasound Cases, by permission)
To distinguish between acute and chronic cholecystitis, a HIDA scan can be done: In chronic cholecystitis, the gallbladder fills slowly (in 1-4 hours), while in acute cholecystitis it does not fill at all .
Types of Chronic Cholecystitis
The exact type of chronic cholecystitis can be determined by a pathologist after gallbladder removal:
- Chronic calculous cholecystitis with an overgrowth of the fibrous tissue in the gallbladder wall and gallstones
- Porcelain gallbladder with a calcified wall, which is considered a risk factor for gallbladder cancer 
- Xanthogranulomatous cholecystitis with a thick gallbladder wall and fatty nodules in it, which can appear similar to gallbladder cancer 
- Chronic acalculous cholecystitis without gallstones, which is usually associated with a chronic disease, such as diabetes mellitus, or an infection
- Cholesterolosis – an accumulation of cholesterol in the gallbladder wall resulting in a strawberry gallbladder appearance
In chronic cholecystitis, the gallbladder is irreversibly changed and does not heal on its own .
Chronic cholecystitis without symptoms and gallbladder calcification may need no treatment.
The usual treatment of chronic cholecystitis with recurrent abdominal pain is surgical gallbladder removal .
In individuals with severe underlying conditions who are not suitable for surgery, chronic cholecystitis can be treated endoscopically by gallbladder drainage and inserting stents into the common bile duct .
Complications of chronic cholecystitis [2,3]:
- Acute cholecystitis
- Gallbladder gangrene
- Gallbladder perforation, which can lead to inflammation of the abdominal membrane (peritonitis) or passage of a gallstone into the intestine and its blockage (gallstone ileus); mainly in elderly
- Gallbladder cancer
- Siddiqui AA, Chronic cholecystitis MSD Manual, Professional version
- Khan AN, Porcelain gallbladder Emedicine
- Schnelldorfer T, 2013, Porcelain gallbladder: a benign process or concern for malignancy? PubMed
- Singh VP et al, 2016, Xanthogranulomatous cholecystitis: What every radiologist should know PubMed Central
- Lukies M et al, Chronic cholecystitis Radiopedia
- The Choking Gall: The Curse of Gallstones Ramsay Sime Darby
- Gutkin E et al, 2012, The Successful Treatment of Chronic Cholecystitis with SpyGlass Cholangioscopy-Assisted Gallbladder Drainage and Irrigation through Self-Expandable Metal Stents PubMed Central