Cholecystitis

Description

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

Etiology

• Acute calculous cholecystitis:
  • Owing to bile stasis secondary to prolonged obstruction by a gallstone (see “Cholelithiasis”) 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:
  • 20% of cases
  • Underlying critical illness leads to biliary stasis and mucosal ischemia
  • Subsequent mucosal inflammation and infection

• 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