Acute Cholecystitis

Acute Cholecystitis – Treatment Options

Introduction
Acute cholecystitis is an acute inflammation of the gallbladder, most commonly caused by cystic duct obstruction from gallstones. Less commonly, it occurs in critically ill patients without gallstones (acalculous cholecystitis). Clinical features include right upper quadrant pain, fever, nausea, and Murphy’s sign. Untreated, it may lead to gallbladder gangrene, perforation, and sepsis. Management combines supportive care, antibiotics, and surgical intervention.

1. Immediate Stabilization

• Hospital admission for all suspected cases.

• NPO (nil per os): Withholding oral intake to rest the gallbladder.

• IV fluids: Crystalloid resuscitation to correct dehydration and maintain hemodynamic stability.

• Analgesia: NSAIDs or opioids for pain control.

• Antiemetics: For nausea and vomiting.

2. Antibiotic Therapy

• Broad-spectrum coverage targeting gram-negative and anaerobic organisms:

  • Ceftriaxone + metronidazole

  • Ampicillin–sulbactam

  • Piperacillin–tazobactam (for severe cases)

  • Carbapenems (for critically ill or resistant infections)

• Duration: Typically 4–7 days, adjusted based on surgical outcome and clinical course.

3. Definitive Management

• Early laparoscopic cholecystectomy (within 24–72 hours):

  • Gold standard treatment for most patients.

  • Reduces complications and risk of recurrence.

• Interval cholecystectomy: In patients unfit for immediate surgery, cholecystectomy is delayed after initial conservative management.

• Percutaneous cholecystostomy:

  • For high-risk surgical patients (elderly, critically ill, multiple comorbidities).

  • Provides temporary decompression and infection control.

4. Supportive and Adjunctive Care

• Nutritional support: Resume oral feeding once acute inflammation subsides.

• DVT prophylaxis: For hospitalized patients awaiting surgery.

• Glycemic control: Important in diabetic patients, as infection can worsen hyperglycemia.

5. Complication Management

• Empyema of gallbladder: Requires urgent surgical drainage.

• Gangrene or perforation: Emergency surgery with possible conversion to open cholecystectomy.

• Pericholecystic abscess: Percutaneous or surgical drainage.

• Sepsis: Broad-spectrum IV antibiotics, fluids, and ICU support as needed.

6. Lifestyle and Preventive Measures

• Long-term: Weight management, healthy diet, and regular exercise to reduce gallstone risk.

• Avoid rapid weight loss or crash diets, which predispose to gallstone formation.

7. Multidisciplinary Care

• General surgeons: For definitive surgical management.

• Gastroenterologists: For diagnostic imaging and ERCP if choledocholithiasis suspected.

• Intensivists: For critically ill or septic patients.

• Nutritionists: For dietary advice post-treatment.