What Are the Symptoms of Cholecystitis?

Cholecystitis is a common benign gallbladder disease, frequently associated with gallstones. It is typically triggered when gallstones obstruct the cystic duct. In rare cases, it may result from obstruction of the cystic duct by gallbladder polyps or gallbladder cancer, followed by secondary infection. Cholecystitis can be classified as either acute or chronic.

What are the symptoms of cholecystitis?

Acute cholecystitis commonly occurs after consuming fatty foods and manifests as severe upper abdominal pain—most pronounced in the right upper quadrant—often accompanied by nausea, vomiting, and fever. Physical examination may reveal marked muscular rigidity and tenderness in the upper abdomen. Ultrasound typically shows significant gallbladder enlargement and marked thickening of the gallbladder wall; in classic cases of acute cholecystitis, a “double-wall sign” may be observed. In severe cases, fluid accumulation may be present around the gallbladder. Chronic cholecystitis primarily presents with right upper quadrant pain, usually dull or vague in nature and milder in intensity, often associated with bloating or other nonspecific gastrointestinal discomfort. Fever is uncommon. Ultrasound reveals diffuse thickening of the gallbladder wall.

Cholecystitis predominantly affects patients with gallstones. Individuals with a prior history of gallstones who develop right upper quadrant pain should be evaluated for possible cholecystitis and referred promptly to a specialized hepatobiliary surgery outpatient clinic for diagnosis and management. Gallbladder polyps and adenomyosis generally do not cause cholecystitis; however, if such lesions are located near the gallbladder neck, they may potentially trigger cholecystitis.

How is cholecystitis treated?

Acute cholecystitis is frequently associated with gallstones. During an acute episode, strict fasting is required, and patients should seek hospital care for antimicrobial therapy and intravenous fluid resuscitation. Emergency surgical intervention may be necessary in certain cases. For patients managed conservatively, oral intake may be gradually resumed once infection is controlled—starting with bland, low-residue foods and progressing stepwise to a low-fat regular diet. Elective surgery should be considered approximately 45 days after resolution of the inflammatory episode.

Patients with chronic cholecystitis should maintain a low-fat regular diet and undergo periodic ultrasound examinations to monitor changes in gallbladder wall thickness. Elective cholecystectomy is recommended for patients whose gallbladder wall thickness exceeds 5 mm. For those unwilling to undergo surgery, strict dietary control and regular follow-up imaging are essential.

We hope this information is helpful to you.