Cholecystitis is the inflammation and/or infection of the gallbladder. It can be a sudden event as Acute Cholecystitis, or simmer and recur as Chronic Cholecystitis.
The gallbladder is a small organ in the upper right abdomen, it lies beneath the liver and it is connected to the bile duct. The gallbladder stores bile, a liquid produced by the liver that helps the body digest oily and fatty food. Before a meal, the gallbladder is filled with bile; during and after meals, the gallbladder squeezes the stored bile into the small intestine through a tube called the common bile duct.
In most cases, gallstones blocking the tube (cystic duct) leading out of the gallbladder cause cholecystitis. This results in swelling (inflammation) and may lead to infection. Other causes of cholecystitis include bile duct problems and tumours.
If left untreated or delayed, cholecystitis can lead to serious and sometimes life-threatening complications e.g., gallbladder rupture (perforation) or tissue death (gangrenous cholecystitis). Treatment for cholecystitis often involves surgery to remove the gallbladder (cholecystectomy)
Signs and Symptoms
- Severe pain in upper right or centre of the abdomen
- Pain that spreads to your right shoulder or back
- Tenderness over your right upper abdomen when it is pressed
- Nausea & Vomiting
- Fever, chills & rigors
- Tea - coloured urine, pale stools, yellowing of eyes & skin- Jaundice
- Cholecystitis is the often the result of gallstones that develop in your gallbladder. These stones can block the tube (cystic duct) through which bile leaves the gallbladder, causing a build-up of bile leading to inflammation
- A tumour may block and disrupt bile from draining out of the gallbladder properly
- Bile duct blockage
- Scarring or blockage of the common bile duct
- Certain viral infections can trigger gallbladder inflammation
- Infection within the gallbladder
- If bile builds up within your gallbladder, causing cholecystitis, the bile may become infected
- Death of gallbladder tissue
- Untreated or delayed treatment may cause the gallbladder tissue to die (gangrene)
- Burst gallbladder
- A hole(perforation) in your gallbladder may result from gallbladder swelling, infection or death of tissue
- Increase risk of gallbladder cancer
- in patients with recurrent and longstanding infection (Chronic cholecystitis)
You can reduce your risk of cholecystitis by preventing gallstones. Learn more here
Treatment for cholecystitis usually involves a hospital admission to control the inflammation and infection. This involves -
- Fasting - to rest the bowels and to prepare for surgery if necessary
- Fluids - intravenous fluids to prevent dehydration
- Antibiotics - to fight the infection
- Pain medications – to control the pain and provide comfort
The definitive treatment is surgery to remove the gallbladder.
Gallbladder removal surgery is called a cholecystectomy. Usually, this can be done via a “keyhole” surgery involving a few tiny incisions in the abdomen (laparoscopic cholecystectomy). An open procedure, in which a long incision is made in your abdomen, is rarely required.
We routinely perform and recommend early surgery for all patients with acute cholecystitis within the same admission as studies has shown it has many benefits such as shorter hospital stay, fewer future complications.
Once the gallbladder is removed, bile flows directly from your liver into your small intestine, rather than being stored in your gallbladder. You don't need a gallbladder to eat and live normally.
Senior Consultant Hepatopancreatobiliary Surgeon
MBBS, MMed (Surgery), MSc, FAMS, FRCSEd
Prior to private practice, Dr Lee Ser Yee was a founding member and Senior Consultant at the Department of Hepatopancreatobiliary (HPB) and Transplant Surgery at Singapore General Hospital (SGH). He served as the Director of the Laparoscopic programme and the Director of the Surgical Skills Training Program and the SingHealth Surgical Skills Centre.
He started his medical training at the National University of Singapore in 1996 and completed his training in General Surgery, HPB surgery and Liver Transplantation at SGH and National Cancer Centre, Singapore.
He also completed dual USA-fellowships in Advanced Laparoscopic HPB surgery and Liver Transplantation under Professor Daniel Cherqui at the New York Presbyterian Hospital-Weill Cornell Medical Center and a Complex Surgical Oncology clinical fellowship at Memorial Sloan Kettering Cancer Center in New York.