Cholecystitis is one problem that can occur with gallstones. (About 19 in 20 cases of cholecystitis are thought to be caused by gallstones.) What seems to happen is that a gallstone becomes stuck in the cystic duct (this is a tube that drains bile out from the gallbladder into the bile duct.) Bile then builds up in the gallbladder, which becomes stretched (distended). Because of this, the walls of the gallbladder become inflamed. In some cases the inflamed gallbladder becomes infected. An infected gallbladder is more prone to lead to complications (see below).
Other causes of cholecystitis are uncommon
No gallstones are found in about 1 in 20 cases of cholecystitis. In many of these cases it is unclear as to why the gallbladder becomes inflamed and/or infected.
How is cholecystitis diagnosed?
If the typical symptoms develop, then the diagnosis of cholecystitis is highly likely. An ultrasound scan is commonly done to clarify the diagnosis. This is a simple painless test which uses sound waves to scan the abdomen. (These is a separate page which describes ultrasound scans in more detail.) An ultrasound scan can detect gallstones, and also if the wall of the gallbladder is thickened (as occurs with cholecystitis). If the diagnosis is in doubt then other more detailed scans may be done.
What is the treatment for cholecystitis?
You will normally be admitted to hospital. Usually you will not be allowed to eat or drink (to rest the gallbladder), and you will be given fluids and painkillers directly into a vein through a 'drip'. With this initial treatment the gallstone that caused the blockage often falls back into the gallbladder, and the inflammation and symptoms often settle down. If the doctor suspects that the gallbladder has become infected, you will also be given antibiotics directly into a vien through the 'drip'.
In most cases, the gallbladder will be removed by an operation. The operation is called cholecystectomy. In most cases, the operation is done within a few days of being admitted to hospital. Sometimes the operation is delayed for several weeks until after the inflammation has settled down.
Different techniques to remove the gallbladder may be recommended depending on its site, size, and other factors.
- 'Key-hole' surgery is now the most common way to remove a gallbladder. (This is called laparoscopic cholecystectomy.) This operation only needs small cuts in the abdomen with small scars remaining afterwards. The operation is done with the aid of a special telescope that is pushed into the abdomen to see the gallbladder. It is not suitable for all people.
- Some people with gallstones need the traditional operation to remove the gallbladder (cholecystectomy). In this operation a larger cut is needed in the abdomen to get at the gallbladder.
If you do not have your gallbladder removed, there is a reasonable chance that you would have no further problems if the inflammation settles down. However, there is also a good chance that you would have further bouts of cholecystitis in the future. This is why the usual treatment is to remove the gallbladder.
What are the possible complications of cholecystitis?
If treatment is delayed or not available, in some cases the gallbladder becomes severely infected and even gangrenous. This can lead to blood poisoning (septicaemia), which is very serious and can be life-threatening. Other possible complications include: the gallbladder may perforate (burst), or a fistula (channel) may form between the gallbladder and gut as a result of continued inflammation.
After a gallbladder is removed
You do not need a gallbladder to digest food. Bile still flows from the liver to the gut once the gallbladder is removed. However, there is no longer any storage area for bile between meals. The flow of bile is therefore constant, without the surges of bile that occur from a gallbladder when you eat a meal.
You can usually eat a normal diet without any problems after your gallbladder is removed. However, up to half of people who have had their gallbladder removed have some indigestion or bloating from time to time. This may be more noticeable after eating a fatty meal. Some people notice an increase in the frequency of passing stools (motions or faeces) after their gallbladder is removed. This is like mild diarrhoea. It can be treated by anti-diarrhoeal medication if it becomes troublesome.
©EMIS and PIP 2005
