Acute Cholecystitis Questions & Answers

1. [Guideline] Yarmish GM, Smith MP, Rosen MP, et al. ACR appropriateness criteria right upper quadrant pain. J Am Coll Radiol. 2014 Mar. 11(3):316-22. [QxMD MEDLINE Link]. [Full Text].

2. Huffman JL, Schenker S. Acute acalculous cholecystitis: a review. Clin Gastroenterol Hepatol. 2010 Jan. 8(1):15-22. [QxMD MEDLINE Link].

3. Donovan JM. Physical and metabolic factors in gallstone pathogenesis. Gastroenterol Clin North Am. 1999 Mar. 28(1):75-97. [QxMD MEDLINE Link].

4. Sitzmann JV, Pitt HA, Steinborn PA, et al. Cholecystokinin prevents parenteral nutrition induced biliary sludge in humans. Surg Gynecol Obstet. 1990 Jan. 170(1):25-31. [QxMD MEDLINE Link].

5. Cullen JJ, Maes EB, Aggrawal S, et al. Effect of endotoxin on opossum gallbladder motility: a model of acalculous cholecystitis. Ann Surg. 2000 Aug. 232(2):202-7. [QxMD MEDLINE Link].

6. Forbes LE, Bajaj M, McGinn T, et al. Perihepatic abscess formation in diabetes: a complication of silent gallstones. Am J Gastroenterol. 1996 Apr. 91(4):786-8. [QxMD MEDLINE Link].

7. Huang J, Chang CH, Wang JL, et al. Nationwide epidemiological study of severe gallstone disease in Taiwan. BMC Gastroenterol. 2009 Aug 22. 9:63. [QxMD MEDLINE Link]. [Full Text].

8. Lee SW, Yang SS, Chang CS, Yeh HJ. Impact of the Tokyo guidelines on the management of patients with acute calculous cholecystitis. J Gastroenterol Hepatol. 2009 Dec. 24(12):1857-61. [QxMD MEDLINE Link].

9. Tornqvist B, Waage A, Zheng Z, Ye W, Nilsson M. Severity of acute cholecystitis and risk of iatrogenic bile duct injury during cholecystectomy, a population-based case-control study. World J Surg. 2016 May. 40(5):1060-7. [QxMD MEDLINE Link].

10. Gruber PJ, Silverman RA, Gottesfeld S, et al. Presence of fever and leukocytosis in acute cholecystitis. Ann Emerg Med. 1996 Sep. 28(3):273-7. [QxMD MEDLINE Link].

11. Nidimusili AJ, Alraies MC, Eisa N, Alraiyes AH, Shaheen K. Leukocytosis of unknown origin: gangrenous cholecystitis. Case Rep Med. 2013. 2013:418014. [QxMD MEDLINE Link]. [Full Text].

12. Liolios A, Oropello JM, Benjamin E. Gastrointestinal complications in the intensive care unit. Clin Chest Med. 1999 Jun. 20(2):329-45, viii. [QxMD MEDLINE Link].

13. Tsang CF. A rare case of gallstone ileus-the unanswered question. J Surg Case Rep. 2021 Apr. 2021(4):rjab164. [QxMD MEDLINE Link]. [Full Text].

14. Chiu HH, Chen CM, Mo LR. Emphysematous cholecystitis. Am J Surg. 2004 Sep. 188(3):325-6. [QxMD MEDLINE Link].

15. Moscati RM. Cholelithiasis, cholecystitis, and pancreatitis. Emerg Med Clin North Am. 1996 Nov. 14(4):719-37. [QxMD MEDLINE Link].

16. McEvoy CF, Suchy FJ. Biliary tract disease in children. Pediatr Clin North Am. 1996 Feb. 43(1):75-98. [QxMD MEDLINE Link].

17. Ozeki M, Takeda Y, Morita H, et al. Acute cholecystitis mimicking or accompanying cardiovascular disease among Japanese patients hospitalized in a Cardiology Department. BMC Res Notes. 2015 Dec 19. 8(1):805. [QxMD MEDLINE Link].

18. Yates MR 3rd, Baron TH. Biliary tract disease in pregnancy. Clin Liver Dis. 1999. 3:131-147.

19. Zachariah SK, Fenn M, Jacob K, Arthungal SA, Zachariah SA. Management of acute abdomen in pregnancy: current perspectives. Int J Womens Health. 2019. 11:119-34. [QxMD MEDLINE Link]. [Full Text].

20. Singer AJ, McCracken G, Henry MC, et al. Correlation among clinical, laboratory, and hepatobiliary scanning findings in patients with suspected acute cholecystitis. Ann Emerg Med. 1996 Sep. 28(3):267-72. [QxMD MEDLINE Link].

21. Towfigh S, McFadden DW, Cortina GR, et al. Porcelain gallbladder is not associated with gallbladder carcinoma. Am Surg. 2001 Jan. 67(1):7-10. [QxMD MEDLINE Link].

22. Stephen AE, Berger DL. Carcinoma in the porcelain gallbladder: a relationship revisited. Surgery. 2001 Jun. 129(6):699-703. [QxMD MEDLINE Link].

23. Bingener J, Schwesinger WH, Chopra S, et al. Does the correlation of acute cholecystitis on ultrasound and at surgery reflect a mirror image?. Am J Surg. 2004 Dec. 188(6):703-7.

24. Jang T, Aubin C, Naunheim R. Minimum training for right upper quadrant ultrasonography. Am J Emerg Med. 2004 Oct. 22(6):439-43. [QxMD MEDLINE Link].

25. Roe J. Evidence-based emergency medicine. Clinical assessment of acute cholecystitis in adults. Ann Emerg Med. 2006 Jul. 48(1):101-3. [QxMD MEDLINE Link].

26. Rosen CL, Brown DF, Chang Y, et al. Ultrasonography by emergency physicians in patients with suspected cholecystitis. Am J Emerg Med. 2001 Jan. 19(1):32-6. [QxMD MEDLINE Link].

27. Rubens DJ. Hepatobiliary imaging and its pitfalls. Radiol Clin North Am. 2004 Mar. 42(2):257-78. [QxMD MEDLINE Link].

28. Shah K, Wolfe RE. Hepatobiliary ultrasound. Emerg Med Clin North Am. 2004 Aug. 22(3):661-73, viii. [QxMD MEDLINE Link].

29. Kawai R, Hata J, Manabe N, et al. Contrast-enhanced ultrasonography with Sonazoid for diagnosis of gangrenous cholecystitis. J Med Ultrason (2001). 2016 Apr. 43(2):193-9. [QxMD MEDLINE Link].

30. Pereira J, Afonso AC, Constantino J, et al. Accuracy of ultrasound in the diagnosis of acute cholecystitis with coexistent acute pancreatitis. Eur J Trauma Emerg Surg. 2017 Feb. 43(1):79-83. [QxMD MEDLINE Link].

31. Kim YK, Kwak HS, Kim CS, et al. CT findings of mild forms or early manifestations of acute cholecystitis. Clin Imaging. 2009 Jul-Aug. 33(4):274-80. [QxMD MEDLINE Link].

32. Wang A, Shanbhogue AK, Dunst D, Hajdu CH, Rosenkrantz AB. Utility of diffusion-weighted MRI for differentiating acute from chronic cholecystitis. J Magn Reson Imaging. 2016 Jul. 44(1):89-97. [QxMD MEDLINE Link].

33. Sahai AV, Mauldin PD, Marsi V, et al. Bile duct stones and laparoscopic cholecystectomy: a decision analysis to assess the roles of intraoperative cholangiography, EUS, and ERCP. Gastrointest Endosc. 1999 Mar. 49(3 Pt 1):334-43. [QxMD MEDLINE Link].

34. Siddiqui T, MacDonald A, Chong PS, et al. Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a meta-analysis of randomized clinical trials. Am J Surg. 2008 Jan. 195(1):40-7. [QxMD MEDLINE Link].

35. Cox MR, Wilson TG, Luck AJ, et al. Laparoscopic cholecystectomy for acute inflammation of the gallbladder. Ann Surg. 1993 Nov. 218(5):630-4. [QxMD MEDLINE Link].

36. Lo CM, Liu CL, Fan ST, et al. Prospective randomized study of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Ann Surg. 1998 Apr. 227(4):461-7. [QxMD MEDLINE Link].

37. Ikumoto T, Yamagishi H, Iwatate M, Sano Y, Kotaka M, Imai Y. Feasibility of single-incision laparoscopic cholecystectomy for acute cholecystitis. World J Gastrointest Endosc. 2015 Dec 25. 7(19):1327-33. [QxMD MEDLINE Link].

38. Huang H, Zhang H, Yang D, Wang W, Zhang X. Percutaneous cholecystostomy versus emergency cholecystectomy for the treatment of acute calculous cholecystitis in high-risk surgical patients: a meta-analysis and systematic review. Updates Surg. 2021 May 15. [QxMD MEDLINE Link].

39. Zafar SN, Obirieze A, Adesibikan B, Cornwell EE 3rd, Fullum TM, Tran DD. Optimal time for early laparoscopic cholecystectomy for acute cholecystitis. JAMA Surg. 2015 Feb. 150(2):129-36. [QxMD MEDLINE Link].

40. [Guideline] Katz DS, Rosen MP, Blake MA, et al; and Expert Panel on Gastrointestinal Imaging. ACR Appropriateness Criteria® right upper quadrant pain. [online publication]. Reston (VA): American College of Radiology (ACR); 2010. [Full Text].

41. [Guideline] Overby DW, Apelgren KN, Richardson W, Fanelli R. SAGES guidelines for the clinical application of laparoscopic biliary tract surgery. Surg Endosc. 2010 Oct. 24(10):2368-86. [QxMD MEDLINE Link].

42. Wilson E, Gurusamy K, Gluud C, Davidson BR. Cost-utility and value-of-information analysis of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg. 2010 Feb. 97(2):210-9. [QxMD MEDLINE Link].

43. Vazquez Tarragon A, Azagra Soria JS, Lens V, Manzoni D, Fabiano P, Goergen M. Two staged minimally invasive treatment for acute cholecystitis in high risk patients. Hepatogastroenterology. 2013 May. 60(123):466-9. [QxMD MEDLINE Link].

44. Binenbaum SJ, Teixeira JA, Forrester GJ, et al. Single-incision laparoscopic cholecystectomy using a flexible endoscope. Arch Surg. 2009 Aug. 144(8):734-8. [QxMD MEDLINE Link].

45. Wu CH, Chen CC, Wang CJ, et al. Discrimination of gangrenous from uncomplicated acute cholecystitis: Accuracy of CT findings. Abdom Imaging. 2011 Apr. 36(2):174-8. [QxMD MEDLINE Link].

46. Julliard O, Hauters P, Possoz J, Malvaux P, Landenne J, Gherardi D. Incisional hernia after single-incision laparoscopic cholecystectomy: incidence and predictive factors. Surg Endosc. 2016 Oct. 30(10):4539-43. [QxMD MEDLINE Link].

47. Silberfein EJ, Zhou W, Kougias P, et al. Percutaneous cholecystostomy for acute cholecystitis in high-risk patients: experience of a surgeon-initiated interventional program. Am J Surg. 2007 Nov. 194(5):672-7. [QxMD MEDLINE Link].

48. Mutignani M, Iacopini F, Perri V, et al. Endoscopic gallbladder drainage for acute cholecystitis: technical and clinical results. Endoscopy. 2009 Jun. 41(6):539-46. [QxMD MEDLINE Link].

49. Li M, Li N, Ji W, et al. Percutaneous cholecystostomy is a definitive treatment for acute cholecystitis in elderly high-risk patients. Am Surg. 2013 May. 79(5):524-7. [QxMD MEDLINE Link].

50. Lee SS, Park do H, Hwang CY, et al. EUS-guided transmural cholecystostomy as rescue management for acute cholecystitis in elderly or high-risk patients: a prospective feasibility study. Gastrointest Endosc. 2007 Nov. 66(5):1008-12. [QxMD MEDLINE Link].

51. Salameh H, DiMaio CJ. Endoscopic retrograde cholangiopancreatography and endoscopic ultrasound-guided gallbladder drainage. Gastrointest Endosc Clin N Am. 2019 Apr. 29(2):293-310. [QxMD MEDLINE Link].

52. Law R, Baron TH. Endoscopic ultrasound-guided biliary interventions: an update on recent developments. Curr Opin Gastroenterol. 2016 May. 32(3):232-7. [QxMD MEDLINE Link].

53. Anderloni A, Buda A, Vieceli F, Khashab MA, Hassan C, Repici A. Endoscopic ultrasound-guided transmural stenting for gallbladder drainage in high-risk patients with acute cholecystitis: a systematic review and pooled analysis. Surg Endosc. 2016 Dec. 30(12):5200-8. [QxMD MEDLINE Link].

54. [Guideline] Pisano M, Allievi N, Gurusamy K, et al. 2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis. World J Emerg Surg. 2020 Nov 5. 15(1):61. [QxMD MEDLINE Link]. [Full Text].

55. [Guideline] Pisano M, Ceresoli M, Cimbanassi S, et al. 2017 WSES and SICG guidelines on acute calcolous cholecystitis in elderly population. World J Emerg Surg. 2019. 14:10. [QxMD MEDLINE Link]. [Full Text].

56. Greenwald JA, McMullen HF, Coppa GF, et al. Standardization of surgeon-controlled variables: impact on outcome in patients with acute cholecystitis. Ann Surg. 2000 Mar. 231(3):339-44. [QxMD MEDLINE Link].

57. Gutt CN, Encke J, Koninger J, et al. Acute cholecystitis: early versus delayed cholecystectomy, a multicenter randomized trial (ACDC study, NCT00447304). Ann Surg. 2013 Sep. 258(3):385-93. [QxMD MEDLINE Link].

58. Lowenfels A. Is early surgery better for acute cholecystitis?. Medscape Medical News from WebMD. November 6, 2013. Available at http://www.medscape.com/viewarticle/813363. Accessed: December 2, 2013.

59. Khasawneh MA, Shamp A, Heller S, et al. Successful laparoscopic cholecystectomy after percutaneous cholecystostomy tube placement. J Trauma Acute Care Surg. 2015 Jan. 78(1):100-4. [QxMD MEDLINE Link].

60. Knab LM, Boller AM, Mahvi DM. Cholecystitis. Surg Clin North Am. 2014 Apr. 94(2):455-70. [QxMD MEDLINE Link].

61. van Dijk AH, de Reuver PR, Tasma TN, van Dieren S, Hugh TJ, Boermeester MA. Systematic review of antibiotic treatment for acute calculous cholecystitis. Br J Surg. 2016 Jun. 103(7):797-811. [QxMD MEDLINE Link].

62. Escartin A, Gonzalez M, Cuello E, et al. Acute cholecystitis in very elderly patients: disease management, outcomes, and risk factors for complications. Surg Res Pract. 2019. 2019:9709242. [QxMD MEDLINE Link]. [Full Text].

63. Gupta V, Jain G. Safe laparoscopic cholecystectomy: adoption of universal culture of safety in cholecystectomy. World J Gastrointest Surg. 2019 Feb 27. 11(2):62-84. [QxMD MEDLINE Link]. [Full Text].

64. Sekimoto R, Iwata K. Sensitivity of Murphy's sign on the diagnosis of acute cholecystitis: is it really so insensitive? [letter]. J Hepatobiliary Pancreat Sci. 2019 Oct. 26 (10):E10. [QxMD MEDLINE Link]. [Full Text].

65. Yokoe M, Takada T, Strasberg SM, et al, for the Tokyo Guidelines Revision Committee. New diagnostic criteria and severity assessment of acute cholecystitis in revised Tokyo Guidelines. J Hepatobiliary Pancreat Sci. 2012 Sep. 19 (5):578-85. [QxMD MEDLINE Link]. [Full Text].

66. Graglia S, Shokoohi H, Loesche MA, et al. Prospective validation of the bedside sonographic acute cholecystitis score in emergency department patients. Am J Emerg Med. 2021 Apr. 42:15-9. [QxMD MEDLINE Link].

67. Wehrle CJ, Talukder A, Tien L, et al. The accuracy of point-of-care ultrasound in the diagnosis of acute cholecystitis. Am Surg. 2022 Feb. 88 (2):267-72. [QxMD MEDLINE Link].

68. Wertz JR, Lopez JM, Olson D, Thompson WM. Comparing the diagnostic accuracy of ultrasound and CT in evaluating acute cholecystitis. AJR Am J Roentgenol. 2018 Aug. 211 (2):W92-7. [QxMD MEDLINE Link]. [Full Text].

69. Kim E, Bashir R, Lahham S. Point-of-care ultrasound diagnosis of cholecystitis vs adenomyomatosis. Clin Pract Cases Emerg Med. 2019 May. 3 (2):158-9. [QxMD MEDLINE Link]. [Full Text].

70. Knipe H, Jones J. Sonographic Murphy sign. Radiopaedia.org. Available at https://radiopaedia.org/articles/sonographic-murphy-sign-1?lang=us. Revised: Sept 20, 2021; Accessed: July 13, 2022.

71. Hiatt KD, Ou JJ, Childs DD. Role of ultrasound and CT in the workup of right upper quadrant pain in adults in the emergency department: a retrospective review of more than 2800 cases. AJR Am J Roentgenol. 2020 Jun. 214 (6):1305-10. [QxMD MEDLINE Link]. [Full Text].

72. Gilbert DN, Chambers HF, Saag MS, et al, eds. The Sanford Guide to Antimicrobial Therapy 2021. 51st ed. Sperryville, Va: Antimicrobial Therapy, Inc; 2021.

Vinay K Kapoor, MBBS, MS, FRCSEd, FICS, FAMS Professor of HPB Surgery, Mahatma Gandhi Medical College and Hospital (MGMCH), Jaipur, India

Vinay K Kapoor, MBBS, MS, FRCSEd, FICS, FAMS is a member of the following medical societies: Association of Surgeons of India, Indian Association of Surgical Gastroenterology, Indian Society of Gastroenterology, Medical Council of India, National Academy of Medical Sciences (India), Royal College of Surgeons of Edinburgh

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Pfizer Sanofi.

BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Alan A Bloom, MD † Associate Clinical Professor of Medicine, Albert Einstein College of Medicine; Attending Physician, Department of Gastroenterology, Veterans Affairs Hospital, Bronx

Alan A Bloom, MD is a member of the following medical societies: American College of Physicians, American Gastroenterological Association, American Medical Association, American Society for Gastrointestinal Endoscopy, New York Academy of Medicine, New York Academy of Sciences

Disclosure: Nothing to disclose.

Clinton S Beverly, MD Clinical Assistant Professor, Department of Surgery, Mercer University School of Medicine

Clinton S Beverly, MD is a member of the following medical societies: American College of Surgeons and Society of American Gastrointestinal and Endoscopic Surgeons

Disclosure: Nothing to disclose.

Barry E Brenner, MD, PhD, FACEP Professor of Emergency Medicine, Professor of Internal Medicine, Program Director for Emergency Medicine, Case Medical Center, University Hospitals, Case Western Reserve University School of Medicine

Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Jack A Di Palma, MD Director, Division of Gastroenterology, Professor, Department of Internal Medicine, University of South Alabama College of Medicine

Jack A Di Palma, MD is a member of the following medical societies: American College of Gastroenterology and American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Don Gladden, DO Staff Physician, Department of Emergency Medicine, Seton Medical Center Williamson

Don Gladden, DO is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Eugene Hardin, MD, FAAEM, FACEP Former Chair and Associate Professor, Department of Emergency Medicine, Charles Drew University of Medicine and Science; Former Chair, Department of Emergency Medicine, Martin Luther King Jr/Drew Medical Center

Disclosure: Nothing to disclose.

Samuel M Keim, MD Associate Professor, Department of Emergency Medicine, University of Arizona College of Medicine

Samuel M Keim, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Public Health Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Alexandre F Migala, DO Staff Physician, Department of Emergency Medicine, Denton Regional Medical Center

Alexandre F Migala, DO is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Osteopathic Association, Association of Military Osteopathic Physicians and Surgeons, and Texas Medical Association

Disclosure: Nothing to disclose.

Anil Minocha, MD, FACP, FACG, AGAF, CPNSS Professor of Medicine, Director of Digestive Diseases, Medical Director of Nutrition Support, Medical Director of Gastrointestinal Endoscopy, Internal Medicine Department, University of Mississippi Medical Center; Clinical Professor, University of Mississippi School of Pharmacy

Anil Minocha, MD, FACP, FACG, AGAF, CPNSS is a member of the following medical societies: American Academy of Clinical Toxicology, American Association for the Study of Liver Diseases, American College of Forensic Examiners, American College of Gastroenterology, American College of Physicians, American Federation for Clinical Research, American Gastroenterological Association, and American Society of Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Tushar Patel, MB, ChB Professor of Medicine, Ohio State University Medical Center

Tushar Patel, MB, ChB is a member of the following medical societies: American Association for the Study of Liver Diseases and American Gastroenterological Association

Disclosure: Nothing to disclose.

Rahul Sharma, MD, MBA, FACEP Medical Director and Associate Chief of Service, NYU Langone Medical Center, Tisch Hospital Emergency Department; Assistant Professor of Emergency Medicine, New York University School of Medicine

Rahul Sharma, MD, MBA, FACEP is a member of the following medical societies: American College of Emergency Physicians, American College of Physician Executives, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Peter A D Steel, MA, MBBS Attending Physician, Department of Emergency Medicine, Joan and Sanford I Weill Cornell Medical Center, New York Presbyterian Hospital

Peter A D Steel, MA, MBBS is a member of the following medical societies: American College of Emergency Physicians, British Medical Association, Emergency Medicine Residents Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Alan BR Thomson, MD Professor of Medicine, Division of Gastroenterology, University of Alberta, Canada

Alan BR Thomson, MD is a member of the following medical societies: Alberta Medical Association, American College of Gastroenterology, American Gastroenterological Association, Canadian Association of Gastroenterology, Canadian Medical Association, College of Physicians and Surgeons of Alberta, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Jeffery Wolff, DO Consulting Staff, Department of Gastroenterology, Brooke Army Medical Center; Staff Gastroenterologist, Landstuhl Regional Medical Center

Jeffery Wolff, DO, is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

• Print this section
• Print the entire contents of
• Print the entire contents of article