Can acute cholecystitis lead to a ruptured gallbladder?

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Dainyal Siddiqui, MD

Internal Medicine

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Manuel Jimenez, MD

Cardiology

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Franz Pierre-Louis, MD

Infectious Disease

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Last updated: June 7, 2025 • View editorial policy

From the Guidelines

Yes, acute cholecystitis can lead to a ruptured gallbladder, which is a serious complication that requires immediate medical attention. Acute cholecystitis is inflammation of the gallbladder, typically caused by gallstones blocking the cystic duct. If left untreated, the increasing inflammation and pressure within the gallbladder can compromise its blood supply, leading to tissue necrosis and eventually perforation or rupture. This typically occurs within 3-5 days of untreated severe cholecystitis.

Key Points to Consider

  • The reported incidence of gallbladder perforation in acute cholecystitis is 2–11% 1.
  • Mortality in such cases is as high as 12–16% 1.
  • Symptoms of a ruptured gallbladder include sudden worsening of right upper quadrant pain, fever, nausea, vomiting, and signs of peritonitis such as abdominal rigidity and rebound tenderness.
  • Treatment for a ruptured gallbladder involves emergency surgery (usually laparoscopic cholecystectomy), intravenous antibiotics, and supportive care.
  • Early diagnosis of gallbladder perforation and immediate surgical intervention may substantially decrease morbidity and mortality rates 1.

Management of Acute Cholecystitis

  • Laparoscopic cholecystectomy is a safe and effective treatment for acute cholecystitis 1.
  • Cholecystostomy is a safe and effective treatment for acute cholecystitis in critically ill and/or with multiple comorbidities and unfit for surgery patients 1.
  • Early cholecystectomy is a safe treatment for acute cholecystitis and generally results in shorter recovery time and hospitalization compared to delayed cholecystectomies 1.

From the Research

Acute Cholecystitis and Ruptured Gallbladder

  • Acute cholecystitis (AC) is a relatively frequent disease that can lead to serious complications, including a ruptured gallbladder 2.
  • The complications of acute cholecystitis may result from secondary bacterial infection or mural ischemia secondary to increased intramural pressure, and can include hemorrhagic, gangrenous, and emphysematous cholecystitis, as well as gallbladder perforation 3.
  • Gallbladder perforation is a recognized subtype of complicated cholecystitis, which can cause significant morbidity and mortality, and early diagnosis and recognition play a pivotal role in the management and early surgical planning 3.

Risk of Ruptured Gallbladder

  • The risk of a ruptured gallbladder is higher in patients with complicated cholecystitis, such as those with gangrenous or emphysematous cholecystitis 3.
  • Early laparoscopic cholecystectomy is recommended to reduce the risk of complications, including a ruptured gallbladder 2, 4, 5.
  • Delaying surgery can increase the risk of complications, including a ruptured gallbladder, and is associated with a longer length of hospital stay and higher hospital costs 4.

Management of Acute Cholecystitis

  • The management of acute cholecystitis involves early diagnosis, antimicrobial therapy, and surgical intervention, such as laparoscopic cholecystectomy 2, 4, 5.
  • Percutaneous cholecystostomy is an alternative emergency treatment for acute cholecystitis in patients with severe comorbidities who are not eligible for surgery 6, 5.
  • Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is a potential definitive treatment for calculous acute cholecystitis in non-surgical candidates 6.

References

5
Research

Acute calculous cholecystitis: Review of current best practices.

World journal of gastrointestinal surgery, 2017

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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