Gallbladder & extrahepatic bile ducts


Acute cholecystitis

Topic Completed: 1 September 2012

Minor changes: 8 September 2021

Copyright: 2003-2021,, Inc.

PubMed Search: Acute cholecystitis[TI] gallbladder[TI] full text[sb]

See also: Acute calculous cholecystitis

Hanni Gulwani, M.B.B.S.
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Cite this page: Gulwani H. Acute cholecystitis. website. Accessed September 21st, 2021.
Definition / general
  • Present in 5 - 10% of cholecystectomy specimens
  • Either gallstone associated (acute calculous cholecystitis) or not (acute acalculous cholecystitis)
  • 10% perforate without treatment
  • Note: diagnosis of dysplasia should be made cautiously if extensive ulceration or acute inflammation

Cocaine related:
  • Cholecystectomy
Gross description
  • Enlarged, distended gallbladder
  • Congested vessels ("angry red color"), serosal and mucosal exudate, thickened wall with edema and hemorrhage
  • Ulcers with blood clot, pus and bile
Gross images

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Red mucosa

Acute (with
empyema) and
chronic cholecystitis
with gallstone

Microscopic (histologic) description
  • Initially edema, congestion, hemorrhage, fibrin deposition in and around muscular layer
  • Later mucosal and mural necrosis with neutrophils
  • Variable reactive epithelial changes resembling dysplasia
  • Finally myofibroblastic proliferation with chronic inflammatory infiltrate
  • Also fresh thrombi within small veins
Microscopic (histologic) images

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Reactive changes in acute cholecystitis

Differential diagnosis
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