Cholecystitis

Basics

Description

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

Etiology

  • 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

Pediatric Considerations

  • 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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