Gallbladder
Cholecystitis
Chronic cholecystitis

Author: Hanni Gulwani, M.D. (see Authors page)

Revised: 5 February 2018, last major update September 2012

Copyright: (c) 2003-2018, PathologyOutlines.com, Inc.

PubMed Search: Chronic cholecystitis[TI] gallbladder[TI]

See also: Diffuse lymphoplasmacytic acalculous cholecystitis
Cite this page: Gulwani, H. Chronic cholecystitis. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/gallbladderchroniccholecystitis.html. Accessed October 23rd, 2018.
Definition / general
  • Most cholecystectomies are performed for intermittent obstruction of gallbladder neck / cystic duct by gallstones, causing biliary colic
  • 95% are associated with cholelithiasis
  • 75% women, ages 40+
  • Bacteria present in 11 - 30%, similar organisms as in acute cholecystitis
  • Complications: acute cholecystitis, acute pancreatitis, biliary fistulas, choledocholithiasis, gallstone ileus
  • IBD related changes: two inflammatory patterns that occur more often in ulcerative colitis patients are marked chronic cholecystitis and acute serositis, while nodular lymphoid aggregates are more common in Crohn's disease patients (J Crohns Colitis 2012;6:895)
  • Giardia lamblia: associated with IgA deficiency, achlorhydria, malabsorption
  • H. pylori: may be present but association with disease is unclear (J Infect Dev Ctries 2009;3:856)
  • Salmonella typhi: associated with chronic carrier states
  • Chronic active cholecystitis: with intraepithelial neutrophils
  • Rokitansky-Aschoff sinuses: tubular structures present within the wall in 90%, likely herniations or diverticula due to increased intraluminal pressure; called Luschka ducts if subserosal
Gross description
  • Variable thickening of gallbladder wall, variable adhesions
Microscopic (histologic) description
  • Mild chronic inflammation with Rokitansky-Aschoff sinuses, granulomas (from ruptured Rokitansky-Aschoff sinuses), smooth muscle hypertrophy
  • Neuromatous hyperplasia, hyalinized collagen, dystrophic calcification, lymphoid aggregates (5%)
  • Variable mucosal changes (normal, atrophic, ulcerated)
  • Variable metaplastic change
Microscopic (histologic) images

Images hosted on other servers:

Thickened wall with Rokitansky-Aschoff sinuses

Atrophic mucosa and fibrotic lamina propria

Metaplastic changes gastric

Intestinal

Differential diagnosis