Chronic cholecystitis

Chronic cholecystitis refers to prolonged inflammatory condition that affects the gallbladder. It is almost always seen in the setting of cholelithiasis (95%), caused by intermittent obstruction of the cystic duct or infundibulum or dysmotility.

Clinical presentation

Patients may have a history of recurrent acute cholecystitis or biliary colic, although some may be asymptomatic.

Pathology

Microscopically, there is evidence of chronic inflammation within the gallbladder wall.

Associations

• gallbladder dysmotility may be present
• the is a possible association between chronic cholecystitis and infection with Helicobacter pylori

Radiographic features

Cross sectional imaging

The most commonly observed cross-sectional imaging findings in the setting of chronic cholecystitis are cholelithiasis and gallbladder wall thickening. The gallbladder may appear contracted or distended, and pericholecystic inflammation is usually absent.

Nuclear medicine

Hepatobiliary scintigraphy may be required to distinguish acute from chronic cholecystitis and to evaluate gallbladder dysmotility by calculation of the gallbladder ejection fraction.

HIDA scan (hepatobiliary iminodiacetic acid scan)

HIDA scan can be of particular benefit in cases where the diagnosis is uncertain and for differentiation from acute cholecystitis. Delayed visualization of the gallbladder between 1-4 hours is a reliable sign of chronic cholecystitis.

Chronic cholecystitis may be diagnosed by calculating the percentage of isotope excreted (ejection fraction) from the gallbladder followingcholecystokinin or after a fatty meal.

Treatment and prognosis

Uncomplicated chronic cholecystitis is usually managed with elective cholecystectomy.

Complications

Recognised complications related to chronic cholecystitis include

• superimposed acute cholecystitis
• gallbladder carcinoma
• biliary-enteric fistula (rare)

See also

• cholecystitis