Pathogenesis and the role of bacteria in acute cholecystitis

Abstract

The objective of this study was to clarify the etiology of acute cholecystitis and the role of bacteria in the bile in this condition. We evaluated 52 patients with acute cholecystitis; 46 had cholesterol stones and 6 had no claculi. In the presence of cystic duct obstruction, circulatory disturbance occurs gradually, but circulatory disturbance alone cannot cause severe inflammation unless a bacterial infection is present. If there is no obstruction, rapid circulatory disturbance produces necrotic changes of the gallbladder wall, which are implicated in a fulminant course. In both instances, bacterial infection may play an important role in fulminant cholecystitis. Bacteria implicated in acute cholecystitis are usually present in the bile before the onset of this disease.

Clinical impact of bloodstream infection on acute cholecystitis indicated for emergency cholecystectomy

“…Pathological deterioration of acute cholecystitis is thought to occur in the following three steps 1,12 . First, intragallbladder cholestasis damages the gallbladder mucosa, and inflammatory mediators are activated.…”

“…Second, the bacteria invade the damaged gallbladder through the portal vein or bile duct. Third, the bacteria implant, proliferate, and infiltrate tissues, and then develop into a bacterial infection 8,12 . Thus, identification of the causative bacteria is an essential step to manage acute cholecystitis 8 .…”

“…Third, the bacteria implant, proliferate, and infiltrate tissues, and then develop into a bacterial infection. 8,12 Thus, identification of the causative bacteria is an essential step to manage acute cholecystitis. 8 In acute cholecystitis, positive rates of bile or gallbladder cultures range from 29% to 54%.…”