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Acute cholecystitis: classification
Last reviewed: 23.04.2024
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Classification of acute cholecystitis
- Catarrhal cholecystitis - inflammation is limited to the mucosa and submucosa.
- Phlegmonous cholecystitis is a purulent inflammation with infiltration of all layers of the gallbladder. Possible ulceration of the mucosa with subsequent exudation of the inflammatory fluid in the peri-bubble space.
- Gangrenous cholecystitis - partial or total necrosis of the wall of the gallbladder. When perforating the walls of the bladder, the bile expands into the abdominal cavity (gangrenous-perforated cholecystitis).
- Isolated emphysematous cholecystitis. It can be calculable and bezkamennym and is characterized by the accumulation of gas in the gallbladder due to the multiplication 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 bladder duct or the pancreatic artery.
Gas cholecystitis is common in men with diabetes mellitus, and is manifested by a picture of severe acute cholecystitis with toxemia, sometimes a palpable formation in the abdominal cavity is detected.
Radiography. On the survey radiographs of the abdominal cavity a sharply outlined gallbladder of pear-shaped form is seen. In some cases, the gas not only fills the cavity of the gallbladder, but also infiltrates its wall and surrounding tissues, without penetrating into the blocked vesicular duct. In the position of the subject standing inside the gallbladder, the liquid level is noted, which is not characteristic of the internal bile fistula.
It is also possible to determine the presence of gas on the CT. Ultrasound is less significant.
Treatment. Large doses of antibiotics, traditional or percutaneous cholecystostomy.
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