Acute cholecystitis and cholangitis

Although stones in the biliary tree (and especially in the gallbladder) are an extremely common (and many times asymptomatic) disorder, they may even be the cause of insidious infections. Acute cholecystitis (AC) is a bacterial infection (most likely preceded by an inflammation of the gallbladder wall) produced by an obstruction of the cystic duct by gallstones. The obstruction results in gallbladder distension, wall edema, inflammation, ischemia, and ultimately bacterial infection, causing necrosis, gangrene, and eventually perforation of the gallbladder wall, with the development of a local abscess or generalized peritonitis. The obstruction is usually caused by gallstones (>90 %), thereby identifying the acute calculous cholecystitis (ACC), but AC may infrequently be acalculous (acute acalculous cholecystitis, AAC) [1]. Instead acute cholangitis is a bacterial infection caused by an obstruction of the biliary tree most commonly from gallstones, independent of the gallbladder and cystic duct (termed choledocholithiasis, CL), resulting in elevated intraluminal pressure and bile infection. CL in many cases can be even associated to AC.