Medical expert of the article
New publications
Acute cholecystitis - Classification
Last reviewed: 06.07.2025
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If you feel that any of our content is inaccurate, out-of-date, or otherwise questionable, please select it and press Ctrl + Enter.
Classification of acute cholecystitis
- Catarrhal cholecystitis - inflammation is limited to the mucous and submucous membranes.
- Phlegmonous cholecystitis is a purulent inflammation with infiltration of all layers of the gallbladder. Ulceration of the mucous membrane with subsequent exudation of inflammatory fluid into the perivesical space is possible.
- Gangrenous cholecystitis is a partial or total necrosis of the gallbladder wall. When the wall of the gallbladder is perforated, bile leaks into the abdominal cavity (gangrenous-perforative cholecystitis).
- Emphysematous cholecystitis is distinguished separately. It can be calculous and noncalculous and is characterized by gas accumulation in the gallbladder due to the proliferation of anaerobic microflora.
- The term "gas cholecystitis" refers to infection of the gallbladder with gas-forming microorganisms E. coli, Cl. welchii or anaerobic streptococci after occlusion of the cystic duct or cystic artery.
Gas cholecystitis usually occurs in men with diabetes mellitus and is manifested by a picture of severe acute cholecystitis with toxemia, sometimes a palpable formation is found in the abdominal cavity.
Radiography. Plain radiographs of the abdominal cavity show a sharply defined pear-shaped gallbladder. In some cases, gas not only fills the cavity of the gallbladder, but also infiltrates its wall and surrounding tissues without penetrating the blocked cystic duct. When the patient is standing, a fluid level is noted inside the gallbladder, which is not typical for an internal biliary fistula.
CT can also detect the presence of gas. Ultrasound is less indicative.
Treatment: High doses of antibiotics, traditional or percutaneous cholecystostomy.
[