All iLive content is medically reviewed or fact checked to ensure as much factual accuracy as possible.
We have strict sourcing guidelines and only link to reputable media sites, academic research institutions and, whenever possible, medically peer reviewed studies. Note that the numbers in parentheses ([1], [2], etc.) are clickable links to these studies.
If you feel that any of our content is inaccurate, out-of-date, or otherwise questionable, please select it and press Ctrl + Enter.
What provokes acute cholecystitis?
Medical expert of the article
Last reviewed: 04.07.2025
[ Pathogenesis of acute cholecystitis
In 96% of cases, the disease begins with obstruction of the cystic duct by a stone, stagnation of bile and irritation of the gallbladder wall. Lipids can penetrate through the Rokitansky-Aschoff sinuses and also cause irritation. Due to the increase in pressure in the gallbladder cavity, the vessels of its wall are compressed, which can lead to infarction and gangrene.
Obstruction of the common bile duct and pancreatic duct causes regurgitation of pancreatic enzymes, which explains some cases of the development of acalculous acute cholecystitis.
Infection plays an important role in the pathogenesis of the disease. Bacteria deconjugate bile salts to form toxic bile acids that damage the mucous membrane of the gallbladder.
Pathomorphology
The gallbladder is dull, grayish-red, and there are richly vascularized adhesions with surrounding tissues. The gallbladder is usually distended, but as the inflammation subsides, its wall contracts and thickens. The cavity of the gallbladder contains turbid fluid or pus (empyema of the gallbladder), the neck may be obstructed by a stone.
Histologically, hemorrhages and moderate edema are detected, most pronounced on the 4th day and decreasing by the 7th day. As acute inflammation resolves, fibrosis develops.
The lymph nodes around the neck of the gallbladder and along the common bile duct are enlarged.
Bacteriological examination. Intestinal microflora (anaerobes in approximately 75% of cases) is usually cultured from the wall of the gallbladder and the bile contained therein.