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Chronic Cholecystitis


Christina C. Lindenmeyer

, MD, Cleveland Clinic

Last full review/revision Sep 2021| Content last modified Sep 2021
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Chronic cholecystitis is long-standing gallbladder inflammation almost always due to gallstones.

Chronic cholecystitis almost always results from gallstones and prior episodes of acute cholecystitis Acute Cholecystitis Acute cholecystitis is inflammation of the gallbladder that develops over hours, usually because a gallstone obstructs the cystic duct. Symptoms include right upper quadrant pain and tenderness... read more (even if mild). Damage ranges from a modest infiltrate of chronic inflammatory cells to a fibrotic, shrunken gallbladder. Extensive calcification due to fibrosis is called porcelain gallbladder.

Symptoms and Signs of Chronic Cholecystitis

Gallstones intermittently obstruct the cystic duct and so cause recurrent biliary colic. Such episodes of pain are not necessarily accompanied by overt gallbladder inflammation; the extent of inflammation does not correlate with the intensity or frequency of biliary colic. Upper abdominal tenderness may be present, but usually fever is not. Fever suggests acute cholecystitis. Once episodes begin, they are likely to recur.

Diagnosis of Chronic Cholecystitis

  • Ultrasonography

Chronic cholecystitis is suspected in patients with recurrent biliary colic plus gallstones. Ultrasonography or another imaging test usually shows gallstones and sometimes a shrunken, fibrotic gallbladder. The diagnosis is made in patients with a history of recurrent biliary colic and ultrasonographic evidence of gallstones. Cholescintigraphy may show nonvisualization of the gallbladder but is less accurate.

Treatment of Chronic Cholecystitis

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Acute Cholecystitis
In which of the following patient populations does acalculous cholecystitis tend to follow a febrile illness without an identifiable infecting organism?
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