Acute cholecystitis - Complications

1. Empyema of the gallbladder is a purulent inflammation of the gallbladder, accompanied by the accumulation of a significant amount of pus in its cavity;

The addition of infection against the background of persistent obstruction of the cystic duct can lead to empyema of the gallbladder. Sometimes empyema complicates endoscopic papillosphincterotomy, especially if stones remain in the duct.

The symptoms correspond to the picture of an intra-abdominal abscess (fever, tension of the muscles of the anterior abdominal wall, pain), but in elderly patients they may be blurred.

Surgical treatment combined with antibiotics is accompanied by a high percentage of postoperative septic complications. An effective alternative method is percutaneous cholecystostomy.

2. Perivesical abscess.
3. Gallbladder perforation. Acute calculous cholecystitis may lead to transmural necrosis of the gallbladder wall and its perforation. Perforation occurs due to pressure of the stone on the necrotic wall or rupture of dilated infected Rokitansky-Aschoff sinuses.

Usually, the rupture occurs at the bottom - the least vascularized area of the gallbladder. The rupture of the gallbladder contents into the free abdominal cavity is rare, usually adhesions with adjacent organs and abscesses are formed. A rupture into a hollow organ adjacent to the gallbladder ends with the formation of an internal biliary fistula.

Symptoms of perforation include nausea, vomiting, and right upper quadrant abdominal pain. In half of cases, a palpable mass is found in this area, and fever occurs with the same frequency. The complication often remains unrecognized. CT and ultrasound help to identify fluid in the abdominal cavity, abscesses, and stones.

There are three clinical variants of gallbladder perforation.

• Acute perforation with biliary peritonitis. In most cases, there is no history of cholelithiasis. Associated conditions include vascular insufficiency or immunodeficiency (atherosclerosis, diabetes mellitus, collagenoses, use of corticosteroids, or decompensated liver cirrhosis). This diagnosis should be primarily excluded in immunocompromised patients (e.g., AIDS patients) with acute abdomen. The prognosis is poor, with a mortality rate of about 30%. Treatment includes high doses of antibiotics, infusion therapy, conventional or percutaneous removal/drainage of gangrenous gallbladder, and drainage of abscesses.
• Subacute perforation with perivesical abscess. History of cholelithiasis, clinical picture intermediate between variants 1 and 3.
• Chronic perforation with formation of a vesicointestinal fistula, for example with the colon.

4. peritonitis;
5. mechanical jaundice;
6. cholangitis;
7. biliary fistulas (external or internal);
8. acute pancreatitis.

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