Gangrenous cholecystitis

by Jason Wasserman MD PhD FRCPC
February 26, 2025

Gangrenous cholecystitis is a severe and life-threatening form of gallbladder inflammation. It happens when the gallbladder does not get enough blood flow, causing its tissues to die. When this occurs, the gallbladder can develop infection, rupture, or serious complications, making emergency treatment necessary.

What are the symptoms of gangrenous cholecystitis?

The symptoms of gangrenous cholecystitis are similar to regular gallbladder inflammation (cholecystitis) but tend to be more severe.

Common symptoms include:

• Severe and persistent pain in the upper right side of the abdomen or middle of the stomach.
• Fever and chills, which may indicate infection.
• Nausea and vomiting.
• A fast heart rate (tachycardia).
• Jaundice (yellowing of the skin and eyes), in some cases.

These symptoms require immediate medical attention, as gangrenous cholecystitis can quickly become life-threatening.

What causes gangrenous cholecystitis?

Gangrenous cholecystitis usually develops from untreated or severe acute cholecystitis, which is inflammation of the gallbladder. The most common cause is gallstones, which block the flow of bile and lead to inflammation. Over time, if the blockage remains, the gallbladder can lose its blood supply, leading to tissue death (gangrene).

Other risk factors include:

• Diabetes or other conditions that affect blood flow.
• Older age.
• Weakened immune system.
• Severe infections that spread to the gallbladder.

How is this diagnosis made?

Doctors diagnose gangrenous cholecystitis based on symptoms, imaging tests, and sometimes surgery. A CT scan or ultrasound of the abdomen may show thickening of the gallbladder wall, dead tissue, or fluid buildup. Blood tests often reveal signs of infection or inflammation. In many cases, the diagnosis is confirmed during surgery to remove the gallbladder (cholecystectomy) when the doctor directly sees the damaged tissue.

Microscopic features

After the gallbladder is removed, a pathologist examines the tissue under a microscope. In gangrenous cholecystitis, the normal gallbladder lining is replaced by necrotic (dead) tissue, and in some areas, no surviving cells remain. There is often a heavy inflammatory response, with large numbers of white blood cells present as the body attempts to fight the infection. Bacteria and cellular debris may also be seen, especially if the gallbladder is infected. Blood vessel damage is another key feature, as the loss of blood supply contributes to tissue death. These microscopic findings confirm the diagnosis and help rule out other conditions affecting the gallbladder.