Acute cholecystitis natural history, complications and prognosis
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Acute Cholecystitis most commonly occurs as a result of the prolonged obstruction of the cystic duct leading to inflammation of the gallbladder. The obstruction further contributes to the development of the complications associated with acute cholecystitis such as gangrene, empyema, perforation, cholecystoenteric fistula, emphysematous cholecystitis, and gallstone ileus. Prognosis is generally good if the patient receives treatment. The majority of the patients undergo cholecystectomy.
Natural History, Complications, and Prognosis
- In calculus cholecystitis, symptoms of acute cholecystitis usually develop after the obstruction of a gallstone in the bile ducts for more than 7 to 10 days. Female sex, obesity, oral contraceptives, and an underlying disease, such as diabetes are associated with the development of acute cholecystitis. Acute cholecystitis presents with the symptoms, such as right upper quadrant abdominal pain (biliary colic), nausea, and vomiting.
|Gangrene||Gangrene of gallbladder is the most common complication of acute cholecystitis, if left untreated and in elderly patients with an underlying disease of diabetes.|
|Empyema||Prolonged untreated acute cholecystitis worsens the inflammation of the gallbladder leading to the collection of pus around the gallbladder called the empyema of the gallbladder.|
|Perforation||Perforation of the gallbladder is a result of the gangrene of the gallbladder and lead to the pericholecystic abscess. Peritonitis may also occur as a result of gallbladder perforation, such patients develop septicemia and have a high mortality rate.|
|Cholecystoenteric fistula||The cholecystoenteric fistula usually occurs due to the perforation of the gallbladder associated with the long-standing pressure necrosis due to gallstones than acute cholecystitis.|
|Emphysematous cholecystitis||It is associated with secondary infection of the gall bladder wall with gas forming organisms i.e Clostridium welchii, other organisms which can be found are Escherichia coli, Staphylococci, Streptococci, Pseudomonas, and Klebsiella.|
|Gallstone Illeus||Gallstone ileus is associated with the passage of gall stone through the cholecystoenteric fistula leading to mechanical obstruction of bowel in the terminal ileum.|
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