Management of Acute Cholecystitis

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General Considerations

ACUTE cholecystitis is essentially a surgical problem. Nearly all cases begin as the result of the mechanical action of gallstones, either by obstruction of the cystic duct or by erosive action on the wall of the gallbladder. Bacterial invasion almost invariably is secondary to the mechanical factor and may occur a matter of days after the onset of symptoms, or not at all. Removal of the gallbladder and its contained stones effects a cure.

It would seem that once the disease has begun and the diagnosis has been established, the therapeutic aim should be prompt cholecystectomy. Yet case anaylses show that delay in surgery is the rule rather than the exception. Further, many internists and family physicians and some surgeons record their belief that operations should not be performed during an acute phase of the disease, and that symptoms should be permitted to subside completely; elective cholecystectomy is then to be performed during a quiescent interval some weeks or months thereafter. It is our belief that in most instances substantial delay is not justified and may result in needless suffering, prolonged loss of the patient’s time from productive activity and, occasionally, in the development of otherwise avoidable complications.

What are the arguments advanced by those who favor procrastination?

1. “Most attacks of gallbladder pain subside spontaneously and promptly.

It is true that the average attack of gallbladder colic — almost always the precursor of acute cholecystitis — will last only a few minutes or an hour or two, or will. . .



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