Complications

Definition: ischemic necrosis of the gallbladder

Etiology: most common complication of acute cholecystitis [7]

Clinical features: difficult to distinguish from uncomplicated acute cholecystitis

Imaging

• Ultrasound: features of acute cholecystitis plus echogenic membranes floating within the gallbladder lumen

• CT with IV contrast: nonenhancement of the gallbladder wall

Treatment: emergency laparoscopic cholecystectomy and empiric antibiotic therapy for biliary infection

Definition: break in the continuity of the gallbladder wall, typically as a consequence of ischemic necrosis

Clinical features: variable; symptoms typically progress rapidly

• May be indistinguishable from uncomplicated acute cholecystitis

• Potentially accompanied by a palpable RUQ mass and/or signs of generalized peritonitis

Imaging : focal defect in the gallbladder wall; extraluminal stone may be visualized

Treatment: emergency laparoscopic cholecystectomy and empiric antibiotic therapy for biliary infection

Definition: distended pus-filled gallbladder

Clinical features: similar to uncomplicated acute cholecystitis

Imaging: gallbladder distention with hyperechoic (on ultrasound) or hyperintense (on CT abdomen with IV contrast) material within its lumen

Treatment [38]

• Empiric antibiotic therapy for biliary infection

• Emergency source control procedure

  • Low surgical risk: laparoscopic cholecystectomy

  • High surgical risk: image-guided percutaneous drainage of empyema followed by interval laparoscopic cholecystectomy

Etiology: may also result from a perforated duodenal or gastric ulcer

Clinical features

• Fever and vomiting

• Diffuse abdominal pain and rigidity

Diagnostics: well-demarcated, subhepatic, nonhomogeneous fluid-density mass which may contain gas

Management

• Treat underlying cause

• IV antibiotics, percutaneous drainage

Definition: chronic inflammation of the gallbladder

Etiology

• Chronic irritation of gallbladder mucosa by cholelithiasis

• Recurrent attacks of acute cholecystitis

Clinical features: recurrent symptoms similar to acute cholecystitis but typically less severe and often self-limiting

Diagnostics

• Laboratory studies: may be normal [39]

• Ultrasound abdomen or CT abdomen with IV contrast:

  • Thickened gallbladder wall

  • No evidence acute inflammatory changes (e.g., pericholecystic fluid);

  • Cholelithiasis commonly present

• HIDA scan: delayed visualization of the gallbladder

• All patients should also be evaluated for choledocholithiasis before treatment

Treatment: elective laparoscopic cholecystectomy

Complications

• Porcelain gallbladder

  • Definition: calcification of the gallbladder wall due to chronic inflammation

  • Imaging (x-ray or noncontrast CT abdomen): focal or diffuse hyperdensity (radiopaque appearance) of the gallbladder wall

  • Clinical significance: a risk factor for gallbladder cancer

  • Treatment: laparoscopic cholecystectomy even if asymptomatic

• Gallbladder cancer

• Cholecystoenetric fistula and gallstone ileus

Pericholecystic abscess

Pyogenic liver abscess

Hemorrhagic cholecystitis

Gallbladder cancer