Cholecystitis is inflammation of the gallbladder, most often caused by a gallstone blocking its outlet. It causes severe, steady pain under the right ribs, often with fever, and is usually treated with early keyhole removal of the gallbladder.
Cholecystitis is inflammation of the gallbladder. In most cases, around 9 in 10, a gallstone blocks the outlet of the gallbladder. Bile is trapped inside, and the gallbladder wall becomes swollen and inflamed. The trapped bile can then become infected.
Less commonly, cholecystitis happens without gallstones (acalculous cholecystitis), usually in people who are already very unwell. Rarely, a tumour or narrowing of the bile ducts blocks the flow of bile.
Repeated, milder episodes are called chronic cholecystitis.
The main symptom is sudden, severe and steady pain in the upper right side of the belly, under the ribs. It can spread to the right shoulder or upper back and often lasts many hours, unlike a short gallstone attack.
The pain often follows a heavy or fatty meal and may be worse when you breathe in deeply or when the area is pressed.
Go to the emergency department, or call 995, if you have severe or persistent upper right belly pain, especially with fever, shivering, yellowing of the skin or eyes, or repeated vomiting. Read how a gallbladder infection affects your whole body.
Upper belly pain can also come from the heart. If you have chest pressure, pain spreading to the arm or jaw, breathlessness or cold sweats, call 995 straight away.
Trapped bile can become infected and the gallbladder can fill with pus (empyema), causing high fever and severe pain.
Severe inflammation can cut off the blood supply to the gallbladder wall, which may die or burst, leading to peritonitis, a life-threatening infection of the abdomen.
Without removing the gallbladder, further attacks are common. Long-standing gallstone disease is also linked to a higher risk of gallbladder cancer, although this is rare.
Your doctor asks about your symptoms and checks for tenderness in the upper right belly.
To look for signs of infection and inflammation, and to check liver function.
The main test. It shows gallstones, a thickened gallbladder wall and fluid around the gallbladder. A CT or MRI (MRCP) scan may be added if needed.
In hospital, fluids, pain relief and antibiotics are given, and eating is paused to rest the gallbladder.
Removing the gallbladder by keyhole surgery, ideally within a week of diagnosis, treats the cause and prevents further attacks.
For people too unwell for surgery, the gallbladder can be drained through the skin (cholecystostomy), with removal once they recover.
If keyhole surgery is not safe because of severe inflammation or scarring, the operation may be converted to open surgery. Dr Kan Yuk Man will explain the options for your situation. See all gallstone treatment options.
Common questions about gallbladder inflammation.
Acute cholecystitis needs prompt medical care. Go to the emergency department or call 995 if you have severe or persistent upper right belly pain, especially with fever, yellow skin or eyes, or repeated vomiting.
Antibiotics, fluids and pain relief help settle an attack, but the gallstone that caused it usually remains. Early keyhole removal of the gallbladder, ideally within a week of diagnosis, is recommended to prevent further attacks.
A thin tube can be placed into the gallbladder through the skin to drain it (percutaneous cholecystostomy). Gallbladder removal is reconsidered once the person is well enough.
Repeated, milder episodes of gallbladder inflammation, usually from gallstones intermittently blocking the outlet. It is generally treated with planned keyhole gallbladder removal.
After emergency care, see Dr Kan Yuk Man to plan treatment and prevent further attacks.
Disclaimer: This article is for general information only and is not a substitute for medical advice. Please consult a qualified doctor for advice specific to your situation.
Clinical guidance based on NICE guideline CG188 (Gallstone disease) and the Tokyo Guidelines 2018 for acute cholecystitis.
