Which factors increase the morbidity and mortality risk of cholecystitis?

Updated: May 20, 2021
  • Author: Alan A Bloom, MD; Chief Editor: BS Anand, MD  more...
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Once complications such as perforation/gangrene develop, the prognosis becomes less favorable. Perforation occurs in 10%-15% of cases. Patients with acalculous cholecystitis have a mortality ranging from 10%-50%, which far exceeds the expected 4% mortality observed in patients with calculous cholecystitis. In patients who are critically ill with acalculous cholecystitis and perforation or gangrene, mortality can be as high as 50%-60%.

The severity of acute cholecystitis also has an impact on the risk of iatrogenic bile duct injury during cholecystectomy. [9]  Tornqvist et al reported a doubling of the risk for sustaining biliary damage in patients with ongoing acute cholecystitis compared to those without acute cholecystitis. Patients with Tokyo grade II (moderate) acute cholecystitis and those with Tokyo grade III (severe) cholecystitis had, respectively, over double and more than eight times the risk of bile duct injury compared to those without acute cholecystitis. The risk of biliary injury was reduced by 52% with intention to use intraoperative cholangiography. [9]

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