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What causes acute cholecystitis?
Last reviewed: 06.07.2025
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The leading role in the development of acute cholecystitis in children belongs to infection (E. coli, staphylococcus, streptococcus, proteus, enterococcus, typhoid bacillus). The pathogenetic role of enzymes and proenzymes of the pancreas entering the bile ducts and gall bladder and provoking acute enzymatic cholecystitis is being studied.
How does acute cholecystitis develop in children?
Infection can enter the bile ducts and gallbladder in various ways:
- ascending route - microorganisms enter the biliary tract from the duodenum through the outlet of the large duodenal papilla. The reflux of duodenal contents is facilitated by insufficiency of the sphincter of Oddi with simultaneous intraduodenal hypertension;
- descending (hematogenous) route - the infection is introduced into the biliary tract from any organ through the systemic circulation;
- The lymphogenous route is due to the fact that the gallbladder and bile ducts are connected by lymphatic vessels with other organs of the gastrointestinal tract. Escherichia coli, Proteus, enterococci and other representatives of opportunistic microflora with nonspecific or inflammatory changes in the intestinal mucosa, provided that the intestinal barrier is highly permeable, are able to penetrate the biliary tract via the lymphogenous and hematogenous routes, as well as per continuitatem.
In the pathogenesis of acute inflammation and necrotic changes in the wall of the gallbladder, an increase in intravesical pressure is of importance. The causes of the disorder are varied, but the main one is a violation of the outflow of bile from the gallbladder due to hypertonicity of the sphincter of Oddi, spasm of the sphincter of the cystic duct (Lutkens), its blockage by lumps of mucus or microliths.
Lysolecithin, converted from bile lecithin by phospholipase A, which is released during trauma to the mucous membrane of the gallbladder, plays a major role in triggering pathological processes.
Increased synthesis of prostaglandins E and F la plays a significant role in the pathogenesis of acute cholecystitis. Due to biliary hypertension, there is a decrease in the blood supply to the mucous membrane of the gallbladder, which contributes to the disruption of the natural barrier for microorganisms. Infection, predominantly anaerobic (75%), increases inflammatory exudation into the lumen of the gallbladder, increasing intravesical pressure and aggravating damage to the mucous membrane of the organ.