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Treatment of acute calculous cholecystitis - UpToDate

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INTRODUCTION Acute cholecystitis is a syndrome of right upper quadrant pain, fever, and leukocytosis associated with gallbladder inflammation. It typically occurs in patients with gallstones (ie, acute calculous cholecystitis [ACC]), while acalculous cholecystitis accounts for a minority (5 to 10 percent) of cases. Complications of acute cholecystitis include gallbladder gangrene or perforation, which can be life-threatening. Patients with ACC usually present with severe and steady abdominal pain in the right upper quadrant or epigastrium, fever, and leukocytosis. A positive Murphy's sign on physical examination supports the diagnosis. In most cases, the diagnosis can be established with an abdominal ultrasound or a cholescintigraphy if the ultrasound is equivocal. (See "Acute calculous cholecystitis: Clinical features and diagnosis".) Cholecystectomy is the mainstay of treatment for ACC. Poor surgical candidates may benefit from initial nonoperative management with antibiotics and a g

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