What is cholecystitis and how should it be treated?

Cholecystitis is a relatively common complication of gallstones. In the UK, approximately 16,700 cholecystectomies are performed to treat it each year.

We recently spoke to leading consultant general surgeon, Mr Martin Sinclair, who subspecialises in upper gastrointestinal surgery, to find out more about the condition. Read on to find out exactly what cholecystitis is, its range of symptoms, and how it should be treated.

What is cholecystitis?

Cholecystitis is an inflammatory condition affecting the gallbladder. The gallbladder is a pear-shaped bile storage organ attached to the liver under the ribs on the right side. There is usually associated infection which can progress to quite serious sepsis in some patients.

Are there different types?

The most common type of cholecystitis is caused by gallstones. The stones block the outlet from the gallbladder, causing inflammation. Rare causes include tumours, bile duct blockage, infections, and narrowing of small blood vessels.
 

What are the causes and symptoms?

The common symptoms include severe pain in the upper abdomen or right side which may radiate to the back or right shoulder. Nausea, fever and tenderness in the upper abdomen may also be prominent. Symptoms are often made worse by eating a fatty meal.
 

Gallstones are the most common cause of cholecystitis. Gallstones form when there is an imbalance in the constituents of bile which allows cholesterol crystals to form, which eventually turn into stones.

This is a bit like what happens when fat globules appear in the washing up bowl when there is not enough washing up liquid (bile salts in the gallbladder). Stones can block the tube (cystic duct) through which bile flows, causing a build up of bile and inflammation of the gallbladder.
 

Other causes include blockage by tumour, bile duct blockage, certain infections, and blood vessel narrowing in vascular disease or diabetes.
 

How is it treated?

Patients with cholecystitis often require hospital admission. Initial treatment includes antibiotics to control infection, intravenous fluids, and painkillers. Most patients will need surgery to prevent recurrent attacks of cholecystitis. An ultrasound scan is required to confirm the diagnosis and sometimes specialised tests are needed (MRI / HIDA / endoscopy).
 

When is surgery needed?

Most patients who have had cholecystitis will need to have the gallbladder removed to prevent further attacks. This can be performed early in the initial illness or several weeks later once the inflammation has settled.
 

Which type of surgery is best?

Keyhole (or laparoscopic) surgery is the most frequently used surgery for gallbladder removal. This is preferred over open surgery as it avoids a painful incision in the upper abdomen. Instead, four small holes are made for keyhole instruments, which are inserted through plastic tubes (ports) after the abdomen is inflated with carbon dioxide gas.

The gallbladder is removed through one of the larger ports (1cm). Patients often ask how this is possible – the gallbladder is usually a long thin organ which can stretch to come through one of the holes after being put in a plastic retrieval bag. Patients are usually able to go home the same day or after an overnight stay. Around two per cent of patients may develop a complication after surgery needing further treatment.
 

Does surgery cure the condition?

Surgery is the only long-term treatment for cholecystitis due to gallstones. The majority of patients are cured by surgery, although a few may experience ongoing symptoms or recurrent gallstones in the future, however this is rare.
 

Is more treatment required after?

Most patients will not need any further treatment except for a wound check at one week and consultant review two weeks postoperatively.

If complications occur after surgery, patients may need further treatment including antibiotics, abdominal drainage, endoscopic procedures, and very rarely, surgery.
 

If you’re suffering from gastrointestinal issues and require surgery, you may wish to book an appointment with an expert in upper gastrointestinal surgery.  Visit Mr Martin Sinclair’s Top Doctors profile to find out more information.