Chronic cholecystitis refers to a persistent and recurrent inflammatory process of the gallbladder. More than 90% of patients with this condition are associated with gallstones.
Pathology
The condition is characterized by fibrous tissue proliferation in the submucosal and subserosal layers, accompanied by mononuclear cell infiltration. Repeated episodes of inflammation may lead to adhesions between the gallbladder and surrounding tissues. Over time, the gallbladder wall thickens and progressively scars, eventually resulting in gallbladder atrophy and a complete loss of function.
Clinical Manifestations
Symptoms are often nonspecific, though many patients have a history of biliary colic. After consuming a large meal or fatty foods, patients may experience abdominal distension and abdominal pain that varies in intensity, often localized to the upper abdomen and sometimes radiating to the right shoulder or back. Fever, chills, or jaundice are uncommon but can occur. Nausea and vomiting may also be present. Physical examination may reveal no obvious positive findings or only mild tenderness in the upper abdomen. Murphy's sign may be positive in some cases.
Diagnosis
Recurrent upper or mid-upper abdominal pain, combined with the presence of gallstones, suggests the diagnosis of chronic cholecystitis. Ultrasound imaging can demonstrate gallbladder wall thickening, impaired gallbladder emptying, or the presence of gallstones. Differential diagnoses include other conditions such as gastritis, reflux esophagitis, peptic ulcers, acute pancreatitis, gastrointestinal tumors, and diseases of the right kidney and ureter.
Treatment
For patients confirmed to have chronic cholecystitis, cholecystectomy is considered the treatment of choice. Non-surgical management, including the use of antibiotics, may be appropriate for those who cannot tolerate surgical intervention.