Acute cholecystitis is sudden inflammation of the gallbladder, almost always triggered by a stone blocking the cystic duct. It is one of the most common general surgical emergencies in the UAE — and one of the most under-recognised by patients, who frequently mistake it for indigestion, gastritis or food poisoning. Untreated, the gallbladder can become gangrenous, perforate, or cause life-threatening sepsis. Treated promptly, it is one of the most satisfying conditions in surgery — most patients are home within 1–2 days of laparoscopic removal. As a female specialist laparoscopic surgeon at Medcare Hospital Al Safa, Dr. Vanesha Varik manages acute gallbladder presentations on a same-day pathway. This guide explains exactly how to recognise acute cholecystitis, why timing matters, and what modern emergency treatment looks like.
What is acute cholecystitis?
The gallbladder is a small pear-shaped organ that stores bile. Bile drains through the cystic duct into the common bile duct. When a stone gets stuck in the cystic duct, bile cannot drain, the gallbladder distends, the wall becomes inflamed, and bacteria multiply inside the trapped bile. The result is acute cholecystitis — a hot, tense, inflamed gallbladder.
In about 5–10% of cases (acalculous cholecystitis) there is no stone — typically in critically ill patients in ICU. The vast majority of cases in healthy outpatients are stone-related (calculous).
How to recognise it
Classic features:
- •Severe constant pain in the right upper abdomen, lasting > 6 hours
- •Pain often radiates to the right shoulder blade
- •Fever (typically 37.5–38.5 °C)
- •Nausea and vomiting
- •Pain worse with deep breath (positive Murphy's sign)
- •Tenderness when the right upper abdomen is pressed
Compare this to simple biliary colic, which usually settles within 4–6 hours and is not associated with fever.
Red-flag features — go to A&E immediately
- •High fever > 38.5 °C with shaking chills (rigors)
- •Yellow tinge to skin or eyes (jaundice)
- •Confusion or low blood pressure
- •Severe abdominal tenderness with rigidity
- •Persistent vomiting unable to keep down fluids
These suggest gangrenous cholecystitis, perforation, ascending cholangitis or sepsis — true surgical emergencies.
How it is diagnosed
- •Clinical examination (Murphy's sign)
- •Blood tests: raised white cell count, raised CRP, often raised LFTs
- •Abdominal ultrasound: gallstones, thickened gallbladder wall (> 4 mm), pericholecystic fluid, sonographic Murphy's sign
- •MRCP if bile duct stones suspected (raised bilirubin/ALP)
- •HIDA scan in equivocal cases
Modern treatment: early laparoscopic cholecystectomy
International guidelines (Tokyo Guidelines 2018) strongly recommend early laparoscopic cholecystectomy within 72 hours of symptom onset for fit patients with acute cholecystitis. Compared with delayed surgery (6 weeks later), early surgery offers:
- •Shorter total hospital stay
- •Lower complication rate
- •Lower conversion-to-open rate
- •Avoids re-admission with another attack
- •Lower overall cost
Patients are admitted, started on IV fluids and antibiotics, optimised, and operated within 24–72 hours.
When emergency surgery is not safe
In a small group of patients — those presenting late (> 7 days), the very elderly, or those with severe sepsis — immediate surgery may be too risky. In these cases the strategy is:
- •IV antibiotics + supportive care
- •Percutaneous cholecystostomy (drain placed into the gallbladder under ultrasound guidance) if not improving
- •Interval cholecystectomy 6 weeks later when inflammation has settled
Recovery after emergency cholecystectomy
Recovery is slightly slower than elective surgery because of the inflammation, but most patients are:
- •Home in 1–3 days
- •Back at desk work in 1–2 weeks
- •Driving at 1–2 weeks
- •Full activity at 4–6 weeks