Pathophysiology and diagnosis of acute calculous cholecystitis

Abstract

Acute calculous cholecystitis (ACC) is a complication of cholelithiasis and is defined as the inflammation of the gallbladder, caused by the obstruction of the cystic duct, by gallstones, or biliary sludge. ACC accounts for 3-11% of hospital admissions and carries a mortality of about 0.8%. The extended gallbladder outlet obstruction by a stone is the initial and main factor leading to an ACC. Bacteria do not play neither an initial nor a major role in ACC, but secondary infection may complicate up to 50% of the cases. The Tokyo Guidelines (2013, 2018) help in establishing a methodology to aid in the diagnosis and severity of acute cholecystitis. Diagnosis is based on the following factors: clinical history, physical examination, laboratory results, and imaging findings, being ultrasonography the most widely used.