Cholecystitis

Basics

Cholecystitis is caused by an inflammatory/infectious process involving the gallbladder (GB) wall, in most cases due to impacted gallstones

Acute calculous cholecystitis:
- Owing to bile stasis secondary to prolonged obstruction by biliary sludge or gallstone in the GB neck, cystic duct, or common bile duct
- Leads to increased intraluminal pressure and mucosal ischemia of the GB wall
- Release of inflammatory mediators results in distention, edema, and increased vascularity
- Bacterial inflammation involved in 50–58% of cases typically a secondary event occurring late in course of disease
Acalculous cholecystitis:
- 5–10% of cases
- Etiology multifactorial: associated with diabetes, HIV, total parenteral nutrition, postoperative state, and critical illness such as burns or sepsis

Acute calculous cholecystitis extremely rare in childhood (see “Cholelithiasis”)
Acalculous cholecystitis more common than calculous form in children:
- Associated with systemic bacterial infections, scarlet fever, Kawasaki disease, and parasitic infections

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