Chronic cholecystitis natural history, complications and prognosis
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Cholecystitis presents with abdominal pain, which is not relieved by antacids and postural changes and lasts longer than 6 hours. It is sometimes preceded by attacks of biliary pain (due to gallstones). Untreated cholecystitis resolves spontaneously in half of the uncomplicated cases without surgery in a span of 7 - 10 days. The complications of chronic cholecystitis include gangrenous cholecystitis, perforation of the gallbladder, Mirizzi syndrome, gallstone ileus, and gallbladder malignancies.
The natural history of chronic cholecystitis is as under:
- Cholecystitis presents with abdominal pain, which is not relieved by antacids and postural changes and lasts longer than 6 hours.
- It is sometimes preceded by attacks of biliary pain (due to gallstones).
- Fever may not be a prominent symptom at the time of presentation but can be seen if untreated or complicated by infections.
- Untreated cholecystitis resolves spontaneously in half of the uncomplicated cases without surgery in a span of 7 - 10 days.
- The remaining cases can progress to complications and cause severe morbidity and mortality.
The complications of chronic cholecystitis include:
- Gangrenous cholecystitis may occur following severe inflammation that interrupts the blood flow to the gallbladder. It is potentially more life-threatening because the dead tissues are vulnerable to secondary severe infections, which can spread to become sepsis.
- CT scan is a better tool in the evaluation of gangrenous cholecystitis. The mortality rate of gangrenous cholecystitis is as high as 22% since it can lead to gallbladder perforation, abscess formation and peritonitis. So once suspected, an emergency cholecystectomy is done to reduce the morbidity and mortality due to its life threatening complications.
Gallstone ileus is the result of mechanical obstruction of the small bowel due to the gallstones. Gallstones reach the bowel through a fistulous channel between gallbladder and the small intestine.
- The following growths may arise in chronic gallbladder infection:
Uncomplicated cholecystitis has a favorable prognosis. Complicated cases can be treated successfully with surgery and they usually do well.
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