Cholecystitis is an inflammation of the gallbladder. The gallbladder becomes distended, and severe complications can arise. It can happen when a gallstone gets stuck at the opening of the gallbladder. Symptoms can include fever, pain, and nausea.

Without treatment, cholecystitis can result in perforation of the gallbladder, tissue death, gangrene, secondary bacterial infections, and fibrosis and shrinking of the gallbladder.

Acute cholecystitis starts suddenly, whereas chronic cholecystitis develops slowly over time. In the United States, approximately 200,000 people get acute cholecystitis every year.

According to research, between 90% and 95% of people with cholecystitis have gallstones, which can form from cholesterol, a pigment called bilirubin, or a mix of the two. Cholecystitis can also occur when biliary sludge collects in the biliary ducts. Alternative causes are also possible, but they happen less frequently.

This article discusses the causes, symptoms, risk factors, and complications of cholecystitis.

The gallbladder is a small, pear-shaped organ connected to the liver on the right side of the abdomen. It stores bile and releases it into the small intestine to help with the digestion of fat.

The gallbladder holds a fluid called bile, which it releases after a person eats to aid digestion. This is particularly important following a meal that is high in fat. The bile travels out of the gallbladder through the cystic duct — a small tube that leads to the common bile duct — and into the small intestine.

The main cause of cholecystitis is gallstones or biliary sludge becoming trapped at the gallbladder’s opening. Doctors may sometimes refer to this as a pseudolith, meaning a “fake stone.”

Other possible causes include:

  • injury to the abdomen from burns, sepsis, trauma, or surgery
  • shock
  • immune deficiency
  • prolonged fasting
  • vasculitis

The signs and symptoms of cholecystitis include right upper quadrant pain, fever, and a high white blood cell count. Pain generally occurs around the gallbladder, in the right upper quadrant of the abdomen.

Acute cholecystitis

In cases of acute cholecystitis, the pain starts suddenly. It does not go away, and it is intense. Without treatment, it will usually get worse, and breathing in deeply will make it feel more intense. The pain may radiate from the abdomen to the right shoulder or back.

Other symptoms may include:

  • abdominal bloating
  • tenderness in the upper-right part of the abdomen
  • little or no appetite
  • nausea
  • vomiting
  • sweating

A slight fever and chills may be present with acute cholecystitis.

After a meal, especially one that is high in fat, the symptoms will worsen. A blood test may reveal a high white blood cell count.

Chronic cholecystitis

People with chronic cholecystitis often experience a similar type of pain, but it tends to occur primarily in the evenings or at night.

The symptoms usually appear gradually over the course of weeks or months, and people do not typically experience fever or chills. The pain may worsen over time, and the condition can progress to the acute version.

A doctor will usually ask whether a person has a history of cholecystitis because it often recurs. They will also determine how tender the gallbladder is by performing a physical examination.

In some cases, they may order the following tests:

  • Complete blood count: A high white blood cell count may indicate an infection. High levels of bilirubin, alkaline phosphatase, and serum aminotransferase may also help the doctor make a diagnosis. However, these markers may not be present in the chronic version.
  • CT scans or ultrasound: Images of the gallbladder may reveal signs of cholecystitis.
  • Hepatobiliary iminodiacetic acid (HIDA) scan: Also known as cholescintigraphy, hepatobiliary scintigraphy, or hepatobiliary scan, this scan creates pictures of the liver, gallbladder, biliary tract, and small intestine.

The information from these tests allows the doctor to track the production and flow of bile from the liver to the small intestine. In doing so, they can determine whether there is a blockage and, if so, confirm its location.

Some people with cholecystitis may require hospitalization. They may have to refrain from consuming any solid or liquid foods for some time. Instead, they will receive liquids intravenously, alongside pain medication and antibiotics.

Surgery

In many cases, doctors will recommend surgery for acute cholecystitis because there is a high rate of recurrence from inflammation related to gallstones.

If there is a low risk of complications, the person can have surgery in an outpatient procedure. If a person is already experiencing complications, they will need immediate surgery to remove the gallbladder. If an infection is present, the doctor may insert a tube through the skin into the gallbladder to drain it.

Surgeons can perform gallbladder removal, called a cholecystectomy, through an open abdominal excision or a laparoscopy.

Laparoscopic cholecystectomy involves creating several small incisions in the skin. The surgeon inserts a camera into one incision to help them see inside the abdomen. They then insert the tools for removing the gallbladder through the other incisions. The benefit of laparoscopy is that the incisions are small, so people usually have less pain after the procedure and less scarring.

Following the surgical removal of the gallbladder, the bile will flow directly into the small intestine from the liver. This does not usually affect the person’s overall health and digestive system, but some individuals may have more frequent episodes of diarrhea.

Diet

After recovering from the condition, it is important to make dietary adjustments that help return bile production to normal.

A person should eat smaller meals more frequently and avoid large servings or portions, as these can upset the system and produce a gallbladder or bile duct spasm.

A person should also avoid high fat and fried foods, including whole milk products, and stick to eating lean proteins.

Various risk factors may increase the risk of developing acute cholecystitis. These include:

  • diabetes
  • history of a critical illness or physical trauma
  • prolonged fasting
  • shock
  • immune deficiency
  • vasculitis

In addition, the following factors may increase people’s risk of chronic cholecystitis:

  • rapid weight loss
  • obesity
  • older age
  • pregnancy
  • being assigned female at birth
  • being of Hispanic or Pima Indian descent

As gallstones are associated with the majority of cholecystitis cases, getting gallstones is a risk factor for the condition. Factors that increase the risk of getting gallstones include an increase in estrogen, giving birth two or more times, older age, and a high body mass index (BMI).

Long labor during childbirth can also damage the gallbladder, raising the risk of cholecystitis during the following weeks.

Untreated chronic or acute cholecystitis can lead to:

  • Fistula: This occurs when a large stone erodes the wall of the gallbladder. This can link the gallbladder and the duodenum, resulting in a leak of stomach acid.
  • Gallbladder distention: If the gallbladder becomes inflamed because of bile accumulation, it may stretch and swell, causing pain. There is then a much higher risk of perforation, or tearing, in the gallbladder, as well as infection and tissue death.
  • Infection of the gallbladder: Bacteria that proliferate in the gallbladder cause this rare and life threatening complication, which is known as emphysematous cholecystitis. People who also have diabetes are more at risk.
  • Cholestasis: This is a rare complication in which the bile duct becomes blocked, and bile is unable to flow.
  • Pancreatitis: Pancreatitis occurs when gallstones pass from the gallbladder into the biliary tract, leading to an obstruction of the pancreatic duct.

Additional complications that can occur include an abscess in the abdomen, bleeding, liver damage, bowel damage, and gallstones that remain in the bile duct.

Some measures can reduce the risk of developing gallstones, which can decrease the likelihood of cholecystitis. These measures include:

  • avoiding saturated and trans fats
  • keeping to regular breakfast, lunch, and dinner times and not skipping meals
  • getting regular physical exercise
  • losing excess body weight, as obesity increases the risk of gallstones
  • avoiding rapid weight loss, as this increases the risk of developing gallstones

The Centers for Disease Control and Prevention (CDC) recommend aiming to lose about 1–2 pounds of body weight per week, which equates to about 0.5 kilograms (kg) to 1 kg. The closer a person is to their ideal body weight, the lower their risk of developing gallstones.

With appropriate treatment, which is usually a cholecystectomy, most people with cholecystitis will recover and have a good outlook. However, in rare cases, surgical complications can occur.

If gallstones are not responsible for the condition, people will usually have another injury or disease that could be life threatening. In such cases, prompt treatment and ongoing monitoring in a hospital setting are even more crucial.

Below, we answer some questions that people may ask about cholecystitis.

Can cholecystitis go away on its own?

Although it is possible for cholecystitis to resolve on its own, any improvement is likely only temporary. If the cause is the gallbladder, a person will usually need to undergo the removal of this organ. Regardless of the cause, a person may wish to receive treatment to rule out other serious underlying conditions and prevent complications.

What is gangrenous cholecystitis?

Gangrenous cholecystitis is a serious complication of acute cholecystitis that results in tissue death. If gallbladder tissue dies, gangrene develops and leads to the perforation or bursting of the bladder. Without treatment, this can lead to sepsis and death.

What is the difference between cholecystitis and cholangitis?

Cholecystitis is inflammation of the gallbladder wall that is typically due to a gallstone obstruction of the bile ducts. Cholangitis is an inflammation of the bile ducts themselves.