From the Guidelines
Gallbladder pain is an emergency when it is associated with severe hemodynamic instability, diffuse intra-abdominal infection, or signs of complicated acute cholecystitis, requiring immediate medical attention and possibly urgent surgical intervention, as indicated by the most recent guidelines 1.
Key Indicators of Emergency
- Severe and persistent pain
- Fever over 101°F
- Yellowing of the skin or eyes (jaundice)
- Severe nausea and vomiting that prevents keeping down liquids
- Pain that radiates to the shoulder or chest
- Dark urine, clay-colored stools, or confusion
Treatment Approach
The treatment approach for emergency gallbladder pain involves:
- IV antibiotics, such as piperacillin-tazobactam or ceftriaxone plus metronidazole
- IV fluids
- Pain management
- Possibly urgent surgical removal of the gallbladder (cholecystectomy)
- Cholecystostomy may be an option in critically ill patients with multiple comorbidities and unfit for surgery or patients who do not show clinical improvement after antibiotic therapy for 3–5 days, as suggested by recent guidelines 1.
Importance of Prompt Treatment
Delaying treatment for severe gallbladder problems can lead to life-threatening complications, including:
- Sepsis
- Peritonitis
- Organ failure
- Bacteria from an infected gallbladder can spread throughout the body, emphasizing the need for prompt medical attention and treatment, as highlighted in recent studies 1.
From the Research
Gall Bladder Pain as an Emergency
Gall bladder pain can be an emergency in certain situations, including:
- Acute cholecystitis, which is diagnosed in approximately 200,000 people in the US each year 2
- Acalculous cholecystitis, which is acute inflammation of the gallbladder without gallstones, typically in the setting of severe critical illness 2
- Choledocholithiasis, cholangitis, biliary pancreatitis, or systemic complications 3
Symptoms and Diagnosis
The typical presentation of acute cholecystitis consists of:
- Acute right upper quadrant pain
- Fever
- Nausea that may be associated with eating
- Physical examination findings of right upper quadrant tenderness 2 Ultrasonography of the right upper quadrant has a sensitivity of approximately 81% and a specificity of approximately 83% for the diagnosis of acute cholecystitis 2
Treatment and Management
Early laparoscopic cholecystectomy (performed within 1-3 days) is associated with improved patient outcomes, including:
- Fewer composite postoperative complications
- A shorter length of hospital stay
- Lower hospital costs 2 In patients who are not eligible for early laparoscopic cholecystectomy, percutaneous or endoscopic gallbladder drainage (GBD) may be required 3 A particular treatment approach should be applied to special populations such as pregnant women, cirrhotic, and elderly patients 3, 4