Diagnosis and Treatment of Cholecystitis

Diagnostic Approach

The World Journal of Emergency Surgery recommends a multi-modal approach for diagnosing cholecystitis, including detailed history, physical examination, laboratory tests, and imaging investigations, with no single clinical or laboratory finding having sufficient diagnostic power to establish or exclude acute cholecystitis 1, 3
Key clinical findings for diagnosing cholecystitis include right upper quadrant pain or tenderness, fever, Murphy's sign with a positive likelihood ratio of 2.8, nausea and vomiting or food intolerance, and possible palpable gallbladder mass in advanced cases 1, 4
Elevated white blood cell count and C-reactive protein are laboratory findings associated with cholecystitis 1, 2
Neutrophil count has shown the strongest association with acute cholecystitis in multivariate analysis, with 70% sensitivity and 65.8% specificity 1

The World Journal of Emergency Surgery recommends early laparoscopic cholecystectomy as the definitive treatment for most patients with cholecystitis, with a preferred timing within 1-3 days of diagnosis 1, 2

Patients should be stratified for risk of common bile duct stones according to clinical, laboratory, and imaging findings, with high-risk patients undergoing preoperative ERCP and moderate-risk patients undergoing second-level examinations such as MRCP, EUS, or intraoperative cholangiography 6
The American College of Surgeons and other surgical guidelines recommend considering percutaneous cholecystostomy tube placement for patients with exceptionally high perioperative risk, although this approach is associated with higher rates of postprocedural complications compared to laparoscopic cholecystectomy 6