Chronic Cholecystitis

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Published: November 28, 2017
Last reviewed: November 29, 2017

Definition

Chronic cholecystitis refers to long-standing gallbladder inflammation with a permanent impairment of the  gallbladder function. [6].

Symptoms

You may have chronic cholecystitis without any symptoms or you may experience recurrent right upper abdominal pain [1]. The presence of nausea and fever suggest acute rather than chronic cholecystitis [1].

Causes

Chronic cholecystitis usually results from recurrent acute cholecystitis, which most commonly occurs as a complication of gallstones (cholelithiasis) [1].

Diagnosis

Diagnosis of chronic cholecystitis can be made by ultrasound, which usually reveals (Picture 1[1]:

  • A shrunken gallbladder with a thick wall
  • One or more gallstones

Chronic cholecystitis

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 [5].

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 [2]
  • Xanthogranulomatous cholecystitis with a thick gallbladder wall and fatty nodules in it, which can appear similar to gallbladder cancer [4]
  • 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

Treatment

In chronic cholecystitis, the gallbladder is irreversibly changed and does not heal on its own [6].

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 [1].

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 [7].

Complications

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
  • References

      1. Siddiqui AA, Chronic cholecystitis  MSD Manual, Professional version
      2. Khan AN, Porcelain gallbladder  Emedicine
      3. Schnelldorfer T, 2013, Porcelain gallbladder: a benign process or concern for malignancy?  PubMed
      4. Singh VP et al, 2016, Xanthogranulomatous cholecystitis: What every radiologist should know  PubMed Central
      5. Lukies M et al, Chronic cholecystitis  Radiopedia
      6. The Choking Gall: The Curse of Gallstones  Ramsay Sime Darby
      7. 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

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