The Diagnosis and Treatment of Acute Cholecystitis: A Comprehensive Narrative Review for a Practical Approach

Abstract

Acute cholecystitis (AC), generally associated with the presence of gallstones, is a relatively frequent disease that can lead to serious complications. For these reasons, AC warrants prompt clinical diagnosis and management. There is general agreement in terms of considering early laparoscopic cholecystectomy (ELC) to be the best treatment for AC. The optimal timeframe to perform ELC is within 72 h from diagnosis, with a possible extension of up to 7–10 days from symptom onset. In the first hours or days after hospital admission, before an ELC procedure, the patient’s medical management comprises fasting, intravenous fluid infusion, antimicrobial therapy, and possible administration of analgesics. Additionally, concomitant conditions such as choledocholithiasis, cholangitis, biliary pancreatitis, or systemic complications must be recognized and adequately treated. The importance of ELC is related to the frequent recurrence of symptoms and complications of gallstone disease in the interval period between the onset of AC and surgical intervention. In patients who are not eligible for ELC, it is suggested to delay surgery at least 6 weeks after the clinical presentation. Critically ill patients, who are unfit for surgery, may require rescue treatments, such as percutaneous or endoscopic gallbladder drainage (GBD). A particular treatment approach should be applied to special populations such as pregnant women, cirrhotic, and elderly patients. In this review, we provide a practical diagnostic and therapeutic approach to AC, even in specific clinical situations, based on evidence from the literature.

Updates on Antibiotic Regimens in Acute Cholecystitis

“…Acute acalculous cholecystitis (AAC) can be distinguished into two forms: primary AAC, associated with a preexisting severe disease, and secondary AAC, which may complicate systemic bacterial, viral, or fungal infections [14,15]. Other risk factors for the development of AAC are total parenteral nutrition, intensive care unit hospitalization, major surgeries, heart attack, stroke, sepsis, severe burns, and extensive trauma [16]. Furthermore, patient carriers of Giardia lamblia, Salmonella typhi, and Helicobacter pylori also have a greater risk of developing AAC [17].…”

Acute Cholecystitis Diagnosis in the Emergency Department: An Artificial Intelligence-based Approach

“…The prognosis of acute cholecystitis is usually excellent, but if left untreated, it may progress to many systemic and localized life-threatening complications [4], which emphasizes the importance of timely and accurate diagnosis with consequent treatment.…”