Acute & Chronic Cholecystitis

Lee Surgery and Endoscopy was founded by Dr. Lee Chin Li, with the mission to deliver accessible and quality healthcare to our patients. We are committed to ensuring your comfort from consultation to procedures.

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Cholecystitis is the inflammation of the gallbladder, often caused by gallstones blocking bile flow, resulting in pain, and infection.

Cholecystitis refers to inflammation of the gallbladder, which is a small pear-shaped organ situated beneath the liver that stores, and concentrates bile. Bile is essential for digesting fats. Most of the time, cholecystitis occurs when a gallstone blocks the cystic duct, preventing bile from leaving the gallbladder. This causes bile to build up, leading to irritation, swelling, and sometimes infection.

Cholecystitis can occur suddenly (acute cholecystitis) or develop gradually over time (chronic cholecystitis). Acute episodes may resolve with treatment, but recurrent inflammation can lead to chronic damage, gallbladder dysfunction, and complications such as scarring or gallbladder shrinkage.

In Singapore, cholecystitis is a common reason for emergency abdominal surgery, particularly in adults over 40 years old. As such, prompt diagnosis, and treatment are key to avoiding complications such as gallbladder rupture or infection spreading to nearby organs.

What are the different types of Cholecystitis?

This may include:

Acalculous cholecystitis – acalculous cholecystitis indicates cholecystitis occurring without gallstones. This form is highly rare as it is more likely in critically ill patients or patient with sepsis. This form of cholecystitis may be triggered by trauma, surgery or severe infection. Additionally, reduced blood flow to the gallbladder may also play a role in its development.
Chronic cholecystitis – when the gallbladder is repeatedly inflamed, it may lead to chronic cholecystitis, in which the gallbladder wall thickens, and its function becomes impaired. This often results from ongoing gallstone irritation or poorly treated acute episodes.
Gallstone-related acute cholecystitis – in 90% to 95% of cases, acute cholecystitis is caused by cholelithiasis, where gallstones block the cystic duct. This obstruction traps bile inside the gallbladder, creating pressure, chemical irritation, and eventually inflammation and infection.

What are the symptoms of cholecystitis?

Cholecystitis commonly arises from gallstones blocking the cystic duct, but infections, and poor circulation can also contribute.

Cholecystitis often presents with a distinct set of symptoms, especially during acute flare-ups. These may resemble gallstone attacks but are typically more severe, and prolonged.

Acute Cholecystitis Symptoms

Fever, and chills, indicating inflammation or infection.
Jaundice, however only in more severe cases if the common bile duct is also blocked.
Loss of appetite.
Nausea, and vomiting due to disrupted digestion.
Pain radiating to the right shoulder or back.
Severe pain in the upper right abdomen that is often constant, and lasting for several hours.
Tenderness over the gallbladder when pressing on the abdomen (Murphy’s sign).

Chronic Cholecystitis Symptoms

Flatulence or burping.
Indigestion or bloating.
Mild nausea.
Recurrent episodes of upper abdominal discomfort, especially after fatty meals.

Who is at risk of Cholecystitis in Singapore?

Cholecystitis can affect individuals of all ages, but certain health, hormonal, and lifestyle factors can increase the likelihood of gallbladder inflammation. In Singapore, the following groups may be at greater risk of developing acute or chronic cholecystitis:

Age — the risk of cholecystitis rises with age, particularly in individuals over 40 years old. With advancing age, gallbladder motility tends to decline, and the risk of gallstone formation increases, both of which contribute to gallbladder inflammation.
Gender — women are more likely to develop cholecystitis, especially during their reproductive years. This is largely due to hormonal influences, such as oestrogen, and progesterone, which can affect bile composition and gallbladder function.
Chronic illness — conditions such as diabetes, liver disease or spinal cord injury can impair gallbladder motility or immune function, making the gallbladder more susceptible to infection, and inflammation.
Infections and systemic illness — acute cholecystitis can occasionally develop without gallstones (acalculous cholecystitis), particularly in those with severe infections, trauma, or sepsis, where the gallbladder becomes inflamed due to reduced blood flow or bile stasis.
Gallstones — having gallstones is the most common cause of cholecystitis. When a stone blocks the cystic duct, it can lead to bile buildup, and gallbladder irritation, often triggering acute inflammation.
Previous episodes of gallbladder disease — individuals who had biliary colic or mild gallbladder inflammation in the past are at increased risk of recurrent or chronic cholecystitis.
Pregnancy or hormone therapy — hormonal fluctuations during pregnancy or from the use of oral contraceptives and hormone replacement therapy can increase bile cholesterol levels and slow gallbladder emptying, raising the risk of gallstone-related cholecystitis.
Obesity and metabolic syndrome — excess body weight, insulin resistance, and high cholesterol can disrupt normal bile composition, promoting gallstone formation, and subsequent inflammation.
Rapid or extreme weight loss — very low-calorie diets or post-bariatric surgery weight loss can lead to cholesterol supersaturation in bile, encouraging gallstone formation, and increasing the risk of cholecystitis.
Fasting or prolonged intravenous feeding — lack of food intake reduces gallbladder contractions, allowing bile to stagnate. This can increase the risk of stone formation, and gallbladder inflammation, particularly in hospitalised or critically ill patients.

How is Cholecystitis diagnosed in Singapore?

Cholecystitis typically causes persistent pain in the upper abdomen, often with fever, and digestive upset.

When cholecystitis is suspected, diagnosis typically involves a combination of clinical assessment, laboratory investigations, and imaging studies. Dr Lee Chin Li will perform a careful, and thorough evaluation to determine the cause of inflammation, and tailor the most appropriate course of treatment.

This includes:

Physical Examination

The diagnostic process begins with a detailed physical examination. During your consultation, we will:

Review your medical history, including any known gallstones or previous episodes of abdominal pain.
Ask about symptoms such as nausea, fever or pain in the right upper abdomen.
Gently palpate the abdomen to detect tenderness, particularly in the upper right quadrant, which may indicate gallbladder irritation (Murphy’s sign).

Diagnostic Tests

If clinical suspicion is high, further tests are used to confirm the diagnosis, and assess the severity of the condition:

Blood Tests – blood tests help identify signs of infection (raised white blood cell count), inflammation (elevated CRP) or liver enzyme abnormalities, which may suggest bile duct involvement.
Abdominal Ultrasound – this is the first-line imaging test for diagnosing cholecystitis. It uses sound waves to visualise the gallbladder, and can detect gallstones, wall thickening, fluid around the gallbladder or signs of bile duct obstruction.
Computed Tomography (CT) Scan – CT scan provides more detailed images of the abdominal organs. It is useful in identifying complications such as gallbladder perforation or abscess formation.
Liver Function Tests – these blood tests assess liver health, and can help determine if bile duct blockage is contributing to the inflammation.

What are the treatment options for Cholecystitis in Singapore?

Treatment depends on the fitness of patient and overall health. In most cases, hospitalisation, and pain control are recommended first. Surgical intervention is typically required in symptomatic cases or in cases with complications.

Non-Surgical Treatment

Non-surgical treatment is the initial step in managing suspected acute cholecystitis, especially if there is ongoing investigations to confirm the diagnosis.

Hospital Admission – patients with suspected cholecystitis are usually admitted for close monitoring, intravenous fluids, and pain management.
Antibiotics – broad-spectrum antibiotics are administered in patient with fever and clinical suspicion of acute cholecystitis.
Pain Relief – analgesics are provided to manage abdominal pain, and discomfort. Non-opioid or opioid medications may be used depending on severity.
Bowel Rest – patients are advised to avoid eating or drinking temporarily to reduce gallbladder stimulation, and allow inflammation to subside.
Nutritional Support – intravenous fluids, and electrolytes are given to maintain hydration, and nutrition during the fasting period.

Surgical Treatment

Surgical removal of the gallbladder (cholecystectomy) is the definitive treatment for most cases of cholecystitis, especially when gallstones are involved.

Laparoscopic Cholecystectomy – this is the most common surgical procedure. It involves small incisions, and a camera-guided removal of the gallbladder. Recovery is typically quicker, with less pain and a lower risk of complications.

Open Cholecystectomy – in more severe cases or if there are complications like gangrene, perforation or extensive scarring, open surgery may be necessary.

Percutaneous Cholecystostomy – for patients who are too ill to undergo surgery, a temporary drainage tube may be placed into the gallbladder to relieve pressure, and infection until they are stable enough for surgery.

Long-Term Management and Prevention

Once recovered, further steps may be recommended to ensure recovery from the inflammation:

Maintain a healthy body weight.
Adopt a balanced, low-fat diet to minimise gallstone formation.
Monitor, and manage chronic conditions such as diabetes or high cholesterol.

Summary

Gallbladder removal via keyhole surgery is the standard treatment for recurrent or severe cholecystitis.

If you are experiencing persistent upper abdominal pain, fever, nausea or other signs of cholecystitis, do not ignore your symptoms. Prompt diagnosis, and timely treatment are essential to prevent serious complications such as gallbladder rupture or bile duct infection.

At Dr Lee Chin Li’s clinic, we offer a patient-focused approach to gallbladder health by combining comprehensive imaging, accurate diagnostics, and personalised treatment plans tailored to your condition. Whether you need medical management or surgery, our team is here to support your recovery every step of the way. Schedule your consultation today for a detailed diagnosis and tailored treatment plan.

Frequently asked questions

Can cholecystitis go away on its own?

Mild cases may improve temporarily with rest and antibiotics, but the underlying problem, especially gallstones, usually requires further treatment to prevent recurrence.

Is gallbladder removal necessary?

In most cases of recurrent or severe cholecystitis, gallbladder removal is the most effective, and permanent solution.

What happens if cholecystitis is not treated?

Untreated cholecystitis can lead to complications such as gallbladder rupture, abscess formation or spread of infection to other parts of the abdomen.

Can I live without a gallbladder?

Yes. After gallbladder removal, bile flows directly from the liver to the intestine. Most people adapt well and will not have much issue with digestion.

How long is the recovery after surgery?

Laparoscopic cholecystectomy usually allows discharge within 1 day, with full recovery in 1 to 2 weeks. However, most patients resume normal activities quickly.

Is cholecystitis always caused by gallstones?

While gallstones are the leading cause, cholecystitis can occasionally occur without stones, particularly in critically ill or fasting patients.

How can I prevent cholecystitis?

A healthy lifestyle, which includes a balanced diet, regular meals, maintaining an ideal weight, and staying active, can reduce the risk of gallstones and subsequent cholecystitis.

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Every patient’s condition is unique. Book a consultation with Dr Lee to discuss your symptoms, get a thorough diagnosis, and explore the most suitable treatment options—including whether surgery is right for you.