The management of patients with acute calculous cholecystitis has changed during recent years. Theetiology of acute cholecystitis is still not fully understood. Infection of bile is relatively unimportant sincebile and gallbladder wall cultures are sterile in many patients with acute cholecystitis. Ultrasonographyis first choice for diagnosis of acute cholecystitis and cholescintigraphy is second best. Percutaneouspuncture of the gallbladder that can be used for therapeutic drainage has also diagnostic qualities. Earlycholecystectomy under antibiotic prophylaxis is the treatment of choice, and has been shown to besuperior to delayed surgery in several prospective trials. Mortality can be as low as 0.5% in patientsyounger than 70–80 years of age, but a high mortality has been reported in octogenerians. Selectiveintraoperative cholangiography is now generally accepted and no advantage of routine cholangiographywas shown in clinical trials. Percutaneous cholecystostomy can be successfully performed underultrasound guidance and has a place in the treatment of severely ill patients with acute cholecystitis.Laparoscopic cholecystectomy can be done safely in patients with acute cholecystitis, but extensiveexperience with this technique is necessary. Endoscopic retrograde drainage of the gallbladder byintroduction of a catheter in the cystic duct is feasible but data are still scarce.
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