| Acute cholecystitis with mild symptoms can be treated conservatively with dietary restriction, analgesics, antibiotics, and follow-up monitoring.
When moderate to severe pain is present, the individual often is admitted to the hospital for intravenous medication and fluids. Medication may include pain relievers (analgesics), antiemetics for nausea and vomiting, and antibiotics. The individual will not be able to receive food by mouth, and a tube may be passed from the nose into the stomach to keep the stomach empty and prevent stimulation of the gallbladder while providing intravenous hydration.
Surgical removal of the gallbladder (cholecystectomy) is the treatment for symptomatic cholecystitis. The preferred technique is laparoscopic cholecystectomy, a minimally invasive procedure performed in about 90% of cases (Gladden). In this procedure, a thin tubular fiber-optic instrument (laparoscope) with a tiny camera attached is inserted through a small abdominal incision, allowing the surgeon to view the gallbladder and perform the surgery. The surgeon incises the gallbladder and removes it using tools passed through another small incision. Patients with suspect perforation, cancer, very large stones, end stage liver disease, bleeding disorders, and some with morbid obesity are not candidates for laparoscopic cholecystectomy.
In an open surgical procedure, a larger incision is made in the abdomen to expose the gallbladder and incise it. Open surgical removal of the gallbladder is performed most often when complications such as perforation of the gallbladder or scarring from previous surgery are encountered during a laparoscopic procedure. Open surgery is needed if the gallbladder has perforated. During cholecystectomy, gallstones often are found within the common bile duct (choledocholithiasis). Stone removal with endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy is an option to treat common bile duct stones or, if the gallbladder is intact, the surgeon may prefer cholecystectomy and exploration of the bile duct.
Treatment of any underlying illness, such as diabetes, pancreatitis, sepsis, hemoglobinopathies, or dehydration is an important aspect of treatment of cholecystitis. If an underlying illness would increase the risks of surgery, surgery can be delayed while that illness is treated; however complicated cases such as acalculous cholecystitis may require immediate emergency surgery. |
Source: Medical Disability Advisor