Acute Cholecystitis from Biliary Lithiasis: Diagnosis, Management and Treatment

Abstract

Biliary lithiasis is a global disorder affecting nearly 20% of the world’s population, although most cases occur without symptoms. Gallbladder stones could move into the common bile duct after gallbladder contraction, causing acute cholecystitis. The progression of the acute disease can take different forms, from mild inflammation, treatable with oral antibiotics, to the most severe forms with septic shock or biliary peritonitis, requiring specific treatment. Liver function tests and abdominal ultrasound are generally sufficient for diagnostic purposes. The most commonly used antibiotic is penicillin, with piperacillin achieving the best results; alternatively, fluoroquinolones could also be used, although there is no univocal consensus and surgery remains the only definitive treatment. A prolonged antibiotic therapy after cholecystectomy seems inadvisable, except in severe cases and/or in the immuno-compromised patient, where it should be periodically evaluated to avoid antibiotic resistance and unnecessary use. This review presents an evidence-based analysis to describe the advantages and disadvantages of the available options for the treatment of biliary lithiasis and cholecystitis, from the pathophysiological mechanisms behind lithiasis formation and also covering the main diagnostic findings for biliary stones, recommending an approach tailored to the patient’s characteristics and to the team’s expertise.

Severe acute cholecystitis successfully treated with endoscopic nasobiliary drainage tube insertion: A case report

“…Acute cholecystitis is a common condition that can vary in severity, ranging from mild inflammation that can be treated with oral antibiotics, to severe cases involving septic shock and biliary peritonitis, which may require specific interventions. 4 Acute cholecystitis is characterized by acute inflammation of the gallbladder, with 95% of cases being attributed to gallstones, known as acute calculous cholecystitis. 5 This is considered to be caused by the impaction of gallstones in the cystic duct, leading to obstruction.…”

Title: Evaluating Nasobiliary and Stent Drainage in Acute Cholecystitis and Cholangitis: Insights from a National Inpatient Survey

“…It is usually caused by an obstruction of the cystic duct by a gall stone [3]. The consequences of not treating acute cholecystitis is the development of gallbladder gangrene, perforation leading to sepsis, shock and peritonitis with mortality approaching 65% [4].…”

Current Management of Acute Cholecystitis: A Narrative Review

“…The common antibiotics that are prescribed include the penicillin group of drugs like amoxycillin clavulanic acid, third generation cephalosporins and fluoroquinolones. There is no consensus with regards to the duration of antibiotic therapy and the clinical situation will dictate the duration of therapy [15][16][17].…”