Surgery in acute cholecystitis

Eighty eight patients presented with symptoms leading to an initial diagnosis of acute cholecystitis over a 12 month period [1986-1987]. Forty eight presented with a palpable gallbladder [Group 1], eight with a vague tender mass in the right upper quadrant [Group 2], and thirty two presented with biliary colic, with minimal abdominal signs, which settled within 24 hours [Group 3]. Jaundice was present in 8 patients [6 in group 1, in group 2]. All patients in group 2, but only 19% in group 3, and 23% in group 1, had a past history of right upper quadrant pain. Surgery was required in 40 Pakistan [46%]. Seventy four and 94% of patients in group 2 and 3 respectively, had fever as against only 6% of patients in group 1. Seventy percent of group 1 patients and 62% of group 2 were operated and during their current admission. Initially, all group 3 patients were treated conservatively, but 2 developed distended gallbladder, and were operated on. Organisms grew from the gall bladder aspirate in only 8 [9%], and only when the bile was dark green. Acute gallbladder disease is more causally related to pressure changes resulting from obstruction than infection. Early operation relieves obstruction and allows and progression of the disease