Cholecystitis is a painful condition caused by an inflamed gallbladder. The most common cause is gallstones.
What is cholecystitis?
Cholecystitis means inflammation of the gallbladder. Most cases are caused by gallstones. Women are affected more often than men. If you have acute cholecystitis you will normally be admitted to hospital for treatment with painkillers and fluids (and sometimes antibiotic medicines) passed directly into a vein.
The inflammation may settle down with treatment. However, surgical removal of the gallbladder is usually advised to prevent further bouts of cholecystitis.
You can find out more about the gallbladder and gallstones in our separate leaflet called Gallstones and Bile.
How do gallstones cause cholecystitis?
Most people with gallstones do not have any symptoms or problems and do not know they have them. Commonly, the stones simply stay in the gallbladder and cause no harm. However, in some people, gallstones can cause problems. See the separate leaflet called Gallstones and Bile for more details.
Cholecystitis is one problem that can occur with gallstones. About 19 in 20 cases of cholecystitis are thought to be caused by gallstones. What seems to happen is that a gallstone becomes stuck in the cystic duct (this is the tube that drains bile out from the gallbladder into the bile duct). Bile then builds up in the gallbladder, which becomes stretched (distended). Because of this, the walls of the gallbladder become inflamed. In some cases the inflamed gallbladder becomes infected. An infected gallbladder is more prone to lead to complications.
The symptoms of acute cholecystitis tend to be quite characteristic. They usually come on rather quickly and you can feel very unwell.
- Pain in the upper tummy (abdomen) - the main symptom. It is usually worse on the right side, under the ribs. The pain may travel (radiate) to the back or to the right shoulder and tends to last several hours. The pain tends to be worse if you breathe in deeply.
- You may also develop a feeling of sickness (nausea).
- You may be sick (vomit).
- You may have a high temperature (fever).
If you are examined by a healthcare professional, they may find you have a positive 'Murphy's sign', meaning that you notice an increase in pain when the doctor places their hand under your ribs on the right hand side, and then asks you to take a deep breath.
What does an ultrasound scan do?
An ultrasound scan is a generally painless test which uses sound waves to scan the tummy (abdomen). It takes around 30 minutes to complete the scan. An ultrasound scan can usually detect gallstones and also whether the wall of the gallbladder is thickened (as occurs with cholecystitis). If the diagnosis is in doubt then other more detailed scans may be done.
Are there any other tests I might need?
In hospital you may also have the following tests:
- Monitoring of your temperature, pulse and blood pressure.
- Assessment of your urine output.
- Blood tests.
- A computerised tomography (CT) scan of the tummy (abdomen).
What else could cause these symptoms?
The symptoms of cholecystitis are quite characteristic but other conditions can sometimes appear similar. These include appendicitis, a stomach ulcer, pancreatitis and pneumonia. All of these can make you seriously unwell so it's important to get the diagnosis right. The tests performed in hospital will help to check the diagnosis.
Unless you are too unwell for surgery, the target set by the National Institute for Health and Care Excellence (NICE) is for your operation to be performed within a week of diagnosis. Different techniques to remove the gallbladder may be used depending on various factors.
- Keyhole surgery is now the most common way to remove a gallbladder. The medical term for this operation is laparoscopic cholecystectomy. It is called keyhole surgery as only small cuts are needed in the tummy (abdomen) with small scars remaining afterwards. The operation is done with the aid of a special telescope that is pushed into the abdomen through one small cut. This allows the surgeon to see the gallbladder. Instruments pushed through another small cut are used to cut out and remove the gallbladder. Keyhole surgery is not suitable for all people.
- Some people need a traditional operation to remove the gallbladder. This is called cholecystectomy. In this operation a larger cut is needed to get at the gallbladder.
- A newer approach called natural orifice transluminal endoscopic surgery (NOTES) is still in the development stage. An operating telescope is inserted into one of the natural openings of the body such as the mouth, anus or vagina to perform the surgery.
Do I have to have surgery?
If you do not have your gallbladder removed, there is a reasonable chance that you will have no further problems if the inflammation settles down. However, there is also a good chance that you would have further bouts of cholecystitis. This is why the usual treatment is to remove the gallbladder.
What you can expect after surgery, including possible complications, is covered in our separate leaflet called Gallstones and Bile.
Further reading and references
Gallstone disease; NICE Clinical Guideline (October 2014)
Gallstone disease; NICE Quality standard, December 2015
Cholecystitis - acute; NICE CKS, January 2017 (UK access only)
Gallstones; NICE CKS, June 2019 (UK access only)
Sanders G, Kingsnorth AN; Gallstones. BMJ. 2007 Aug 11335(7614):295-9.
Liu XY, Li QL, Xu XY, et al; Endoscopic transgastric cholecystectomy: a novel approach for minimally invasive cholecystectomy. Endoscopy. 2021 Feb53(2):E50-E51. doi: 10.1055/a-1180-7661. Epub 2020 Jun 5.