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Symptoms of chronic cholecystitis
Last reviewed: 06.07.2025
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Symptoms of chronic cholecystitis in children begin gradually, last for a long time with periods of worsening (exacerbations) and improvement (remissions). Headaches, fatigue, lethargy, sleep and appetite disturbances occur. Subfebrile temperature, pale skin, dark circles under the eyes, functional changes in the cardiovascular system (tachycardia, bradycardia, arrhythmia, blood pressure surges) are possible.
The cardinal symptom of chronic cholecystitis is abdominal pain. The pain is usually dull, vague, and occurs 30-60 minutes after eating, especially fatty, fried, or high-protein foods. Nausea, heartburn, belching of food and air, bitterness in the mouth, and vomiting (more common in preschool children) are noted. Pain often occurs after physical exertion (running, lifting weights), with body shaking (sports, traveling by transport), due to stress, against the background of or soon after intercurrent diseases, and sometimes for no apparent reason. During an exacerbation of chronic cholecystitis, the pain is severe, paroxysmal, resembling acute abdomen syndrome. Pain radiates to the right shoulder and scapula, and the right lumbar region. The duration of an attack is from several minutes to 0.5-1 hour, rarely longer. Children are repeatedly admitted to hospital with suspected acute appendicitis.
After the pain subsides, children, mainly of school age, complain of heaviness or discomfort in the right hypochondrium (right hypochondrium syndrome) and epigastric region.
The second cardinal symptom of chronic cholecystitis is moderate hepatomegaly. The liver protrudes from under the edge of the costal arch along the right midclavicular line, usually by 2 cm, less often by 3-4 cm, moderately painful on palpation, soft elastic consistency, with a rounded edge.
Yellowish discoloration of the skin and icterus of the sclera are rarely observed (5-7%); in school-age children, in this case, it is necessary to conduct differential diagnostics with Gilbert's syndrome (benign hyperbilirubinemia).
With prolonged chronic cholecystitis and frequent exacerbations, pericholecystitis, periduodenitis, cholangitis, papillitis and other complications may develop. Conditions arise for the formation of stones both in the gallbladder and in the bile ducts. In case of damage to the siphon, the bladder stops functioning (a "disconnected" gallbladder). If adhesions occur between the gallbladder and the right flexure of the colon, Verbraik's syndrome may develop. Children experience recurrent pain in the right upper quadrant of the abdomen or epigastric region, accompanied by nausea and flatulence. Symptoms of chronic cholecystitis are most pronounced during the day, when children are in an upright position, move a lot, and change their body position.
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