Table of ContentsView AllTable of ContentsWhat Is a Pericholecystic Abscess?SymptomsCausesDiagnosisTreatmentPrognosisFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
What Is a Pericholecystic Abscess?
Symptoms
Causes
Diagnosis
Treatment
Prognosis
Frequently Asked Questions
A pericholecystic abscess is an abscess that forms in response to an inflammation of the gallbladder called acutecholecystitis. An abscess is a swollen, fluid-filled area within body tissue.
Pericholecystic fluid is one of the signs of cholecystitis. This is fluid that builds up around the gallbladder and is usually visible on an ultrasound.
The gallbladder is a small sac-like organ that is located under the liver. The gallbladder stores the bile that is produced in the liver and connects to the liver via a series of ducts. The function of bile is to carry away wastes and help to break down and absorb fats and fat-soluble vitamins like vitamins D and K.
Verywell / Laura Porter
Pericholecystic Abscess Symptoms
Often the signs and symptoms of pericholecystic abscess are difficult to differentiate from uncomplicated acute cholecystitis.Uncomplicated acute cholecystitis is a condition involving sudden, severe inflammation of the gallbladder without complications (such as a pericholecystic abscess).
Signs and symptoms of a pericholecystic abscess may include:
Positive Murphy’s Sign
When a patient with cholecystitis takes in a deep breath, holds it, then breathes out while the diagnostician palpates (feels) the right subcostal (below the ribs) area. When pain occurs upon inspiration as the gallbladder comes into contact with the examiner’s hand, this is considered a positive Murphy’s sign.
What Causes a Pericholecystic Abscess?
The primary underlying cause of pericholecystic abscess is a rupture or perforation of the gallbladder that usually occurs secondarily to an acute inflammation of the gallbladder (cholecystitis).
When cholecystitis symptoms are not treated promptly, there is a progression of the disease that can lead to complications, such as pericholecystic abscess and other conditions.
Underlying causes of pericholecystic abscess may include:
According to a 2015 study published in theSingapore Medical Journal, 95% of the acute cholecystitis cases resulted from an obstruction of gallstones in the neck of the gallbladder or in the duct that carries bile from the gallbladder.
Development of a Perichoecystic Abscess
The sequence of events that most commonly lead to a pericholecystic abscess include:
Types of Gallbladder Perforation
There are several different forms of perforation that can occur secondarily to acute cholecystitis, these include:
Once a pericholecystic abscess is formed, it can lead to other complications, including:
Although a few different types of imaging tests are commonly used to diagnose complications of gallbladder disease, a computed tomography (CT) scan is considered the most useful diagnostic tool for detecting a localized perforation with pericholecystic abscesses.
A CT scan (also referred to as a CAT scan) is a type of imaging test that involves taking a series of images of the inside of the body from various angles. It can show pictures that are very detailed of various body parts. Sometimes an iodine-based contrast material is injected into the vein before the scan. This is done to make the images easier to read.
Due to the fact that many emergency departments are equipped with CT scanners these days, there is an increase in the number of patients given CT examinations for suspected acute cholecystitis, according to a 2015 study.This has helped to improve the incidence of early diagnosis and prompt intervention for people with acute cholecystitis.
Other types of imaging tools for diagnosing pericholecystic abscesses include:
MRI (magnetic resonance imaging): A type of imaging test that involves strong magnetic fields and radio waves to produce very detailed pictures of various parts of the body, an MRI can often show more detailed images and is known to be more instrumental in diagnosing specific types of diseases than a CT scan.
Ultrasonography (US) or diagnostic ultrasound: This is a type of imaging test that utilizes high frequency sound waves to produce images of structures inside of the body.
Many diagnosticians consider ultrasound the preferred initial test for evaluating gallbladder stones because it is relatively low in cost, quick to perform, and is highly sensitive in detecting gallstones.
But an ultrasound is not as successful in detecting complications—such as pericholecystic abscesses—and other underlying complications. For diagnosing pericholecystic abcesses, a CT scan or an MRI is preferred.
To treat a pericholecystic abscess, early diagnosis and intervention is the key to successful outcomes. The initial treatment for gallbladder perforation may be percutaneous cholecystostomy.
This is a minimally invasive, image-guided procedure involving the placement of a catheter into the gallbladder to help with stabilization until surgery can be performed to remove the gallbladder if possible.However, in some individuals, gallbladder surgery is not recommended.
There are many reasons that surgery may not be an option for many people with pericholecystic abscess. For example, the advanced stage of cholecystitis (such as when a pericholecystic abscess is present) tends to occur in older people or in those with comorbidity (the presence of two or more diseases or conditions at one time) who have an increased risk of morbidity and mortality.
Gallbladder perforations are a serious complication of acute cholecystitis and represent an advanced stage of the disease. They tend to occur in older people and/or people with comorbidities and carry higher rates of morbidity and mortality.
In many instances, pericholecystic abscesses are not discovered until surgery has begun. But the use of CT scans of the upper abdomen has contributed to the number of people who have received a diagnosis of gallbladder perforation before a standard cholecystectomy (surgery to remove the gallbladder) is performed.
Common treatment modalities for pericholecystic abscesses may include:
Gallbladder perforation with pericholecystic abscess is a rare disorder. It is considered a life-threatening, emergency complication of acute cholecystitis.
With a delay in diagnosis, acute cholecystitis may have an equal mortality (death) rate. This is because prompt treatment modalities are not employed, resulting in progression of the disease.
Study on Pericholecystic Abcess Outcomes
A study involving 238 patients who had a removal of the gallbladder due to gangrenous cholecystitis discovered that:
The study reports that there is a high morbidity (illness) and mortality (death) rate linked with perforation of the gallbladder. In addition, the researchers found that those who were male and those who were at an advanced age were more likely to have perforation of the gallbladder as well as complications after surgery (cholecystectomy).
In conclusion, the study found that early diagnosis and treatment are imperative to improving the prognosis (outcome) of pericholecystic abscess and other complications of gallbladder disease.
Frequently Asked QuestionsPericholecystic fluid is the fluid that surrounds the gallbladder. When a person is believed to have acute cholecystitis, their body can be scanned using asonogram. In addition to searching for issues with the gallbladder, this imaging program can offer a visual of the pericholecystic fluid.Yes, gallbladder rupture can cause death. While there are multiple types of gallbladder perforation, some of which have different effects on the body, one of the most lethal types is known as free perforation (type one) which has a 30% rate of death. This perforation can be the result of generalized biliary peritonitis.There are a large number of diseases and conditions that can cause a thickened gallbladder wall. Some of these include acute cholecystitis,renal failure,cirrhosis, pancreatitis,primary gallbladder carcinoma, acute acalculous cholecystitis (AAC),congestive heart failure, and hepatitis. Both ultrasound and a CT scan can be used to detect gallbladder wall thickening.
Pericholecystic fluid is the fluid that surrounds the gallbladder. When a person is believed to have acute cholecystitis, their body can be scanned using asonogram. In addition to searching for issues with the gallbladder, this imaging program can offer a visual of the pericholecystic fluid.
Yes, gallbladder rupture can cause death. While there are multiple types of gallbladder perforation, some of which have different effects on the body, one of the most lethal types is known as free perforation (type one) which has a 30% rate of death. This perforation can be the result of generalized biliary peritonitis.
There are a large number of diseases and conditions that can cause a thickened gallbladder wall. Some of these include acute cholecystitis,renal failure,cirrhosis, pancreatitis,primary gallbladder carcinoma, acute acalculous cholecystitis (AAC),congestive heart failure, and hepatitis. Both ultrasound and a CT scan can be used to detect gallbladder wall thickening.
10 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Ahad Aziz PA, Weerakkody Y, et al.Gallbladder perforation.Radiopaedia.Bergman A, Neiman H, Kraut B.Ultrasonographic evaluation of pericholecystic abscesses.American Journal of Roentgenology.1979;132(2):201-203. doi:10.2214/ajr.132.2.201National Organization for Rare Disorders (NORD).Acute cholecystititis.Chawla A, Bosco J, Lim T, Srinivasan S, Teh H, Shenoy J.Imaging of acute cholecystitis and cholecystitis-associated complications in the emergency setting.Smedj. 2015;56(08):438-444. doi:10.11622/smedj.2015120Indar AA.Acute cholecystitis.BMJ. 2002;325(7365):639-643. doi:10.1136/bmj.325.7365.639Takada T, Yasuda H, Uchiyama K, Hasegawa H, Asagoe T, Shikata J.Pericholecystic abscess: Classification of US findings to determine the proper therapy.Radiology. 1989;172(3):693-697. doi:10.1148/radiology.172.3.2672094Derici H.Diagnosis and treatment of gallbladder perforation.WJG. 2006;12(48):7832. doi:10.3748/wjg.v12.i48.7832Stefanidis D, Bingener J, Sirinek KR.Predictive factors and outcomes in patients with gallbladder perforation.Journal of Surgical Research. 2004;121(2):318. doi:10.1016/j.jss.2004.07.167Indar AA, Beckingham IJ.Acute cholecystitis.BMJ. 2002;325(7365):639-643. doi:10.1136/bmj.325.7365.639Runner GJ, Corwin MT, Siewert B, Eisenberg RL.Gallbladder wall thickening. AJR Am J Roentgenol. 2014 Jan;202(1):W1-W12. doi:10.2214/AJR.12.10386
10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Ahad Aziz PA, Weerakkody Y, et al.Gallbladder perforation.Radiopaedia.Bergman A, Neiman H, Kraut B.Ultrasonographic evaluation of pericholecystic abscesses.American Journal of Roentgenology.1979;132(2):201-203. doi:10.2214/ajr.132.2.201National Organization for Rare Disorders (NORD).Acute cholecystititis.Chawla A, Bosco J, Lim T, Srinivasan S, Teh H, Shenoy J.Imaging of acute cholecystitis and cholecystitis-associated complications in the emergency setting.Smedj. 2015;56(08):438-444. doi:10.11622/smedj.2015120Indar AA.Acute cholecystitis.BMJ. 2002;325(7365):639-643. doi:10.1136/bmj.325.7365.639Takada T, Yasuda H, Uchiyama K, Hasegawa H, Asagoe T, Shikata J.Pericholecystic abscess: Classification of US findings to determine the proper therapy.Radiology. 1989;172(3):693-697. doi:10.1148/radiology.172.3.2672094Derici H.Diagnosis and treatment of gallbladder perforation.WJG. 2006;12(48):7832. doi:10.3748/wjg.v12.i48.7832Stefanidis D, Bingener J, Sirinek KR.Predictive factors and outcomes in patients with gallbladder perforation.Journal of Surgical Research. 2004;121(2):318. doi:10.1016/j.jss.2004.07.167Indar AA, Beckingham IJ.Acute cholecystitis.BMJ. 2002;325(7365):639-643. doi:10.1136/bmj.325.7365.639Runner GJ, Corwin MT, Siewert B, Eisenberg RL.Gallbladder wall thickening. AJR Am J Roentgenol. 2014 Jan;202(1):W1-W12. doi:10.2214/AJR.12.10386
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Ahad Aziz PA, Weerakkody Y, et al.Gallbladder perforation.Radiopaedia.Bergman A, Neiman H, Kraut B.Ultrasonographic evaluation of pericholecystic abscesses.American Journal of Roentgenology.1979;132(2):201-203. doi:10.2214/ajr.132.2.201National Organization for Rare Disorders (NORD).Acute cholecystititis.Chawla A, Bosco J, Lim T, Srinivasan S, Teh H, Shenoy J.Imaging of acute cholecystitis and cholecystitis-associated complications in the emergency setting.Smedj. 2015;56(08):438-444. doi:10.11622/smedj.2015120Indar AA.Acute cholecystitis.BMJ. 2002;325(7365):639-643. doi:10.1136/bmj.325.7365.639Takada T, Yasuda H, Uchiyama K, Hasegawa H, Asagoe T, Shikata J.Pericholecystic abscess: Classification of US findings to determine the proper therapy.Radiology. 1989;172(3):693-697. doi:10.1148/radiology.172.3.2672094Derici H.Diagnosis and treatment of gallbladder perforation.WJG. 2006;12(48):7832. doi:10.3748/wjg.v12.i48.7832Stefanidis D, Bingener J, Sirinek KR.Predictive factors and outcomes in patients with gallbladder perforation.Journal of Surgical Research. 2004;121(2):318. doi:10.1016/j.jss.2004.07.167Indar AA, Beckingham IJ.Acute cholecystitis.BMJ. 2002;325(7365):639-643. doi:10.1136/bmj.325.7365.639Runner GJ, Corwin MT, Siewert B, Eisenberg RL.Gallbladder wall thickening. AJR Am J Roentgenol. 2014 Jan;202(1):W1-W12. doi:10.2214/AJR.12.10386
Ahad Aziz PA, Weerakkody Y, et al.Gallbladder perforation.Radiopaedia.
Bergman A, Neiman H, Kraut B.Ultrasonographic evaluation of pericholecystic abscesses.American Journal of Roentgenology.1979;132(2):201-203. doi:10.2214/ajr.132.2.201
National Organization for Rare Disorders (NORD).Acute cholecystititis.
Chawla A, Bosco J, Lim T, Srinivasan S, Teh H, Shenoy J.Imaging of acute cholecystitis and cholecystitis-associated complications in the emergency setting.Smedj. 2015;56(08):438-444. doi:10.11622/smedj.2015120
Indar AA.Acute cholecystitis.BMJ. 2002;325(7365):639-643. doi:10.1136/bmj.325.7365.639
Takada T, Yasuda H, Uchiyama K, Hasegawa H, Asagoe T, Shikata J.Pericholecystic abscess: Classification of US findings to determine the proper therapy.Radiology. 1989;172(3):693-697. doi:10.1148/radiology.172.3.2672094
Derici H.Diagnosis and treatment of gallbladder perforation.WJG. 2006;12(48):7832. doi:10.3748/wjg.v12.i48.7832
Stefanidis D, Bingener J, Sirinek KR.Predictive factors and outcomes in patients with gallbladder perforation.Journal of Surgical Research. 2004;121(2):318. doi:10.1016/j.jss.2004.07.167
Indar AA, Beckingham IJ.Acute cholecystitis.BMJ. 2002;325(7365):639-643. doi:10.1136/bmj.325.7365.639
Runner GJ, Corwin MT, Siewert B, Eisenberg RL.Gallbladder wall thickening. AJR Am J Roentgenol. 2014 Jan;202(1):W1-W12. doi:10.2214/AJR.12.10386
Meet Our Medical Expert Board
Share Feedback
Was this page helpful?Thanks for your feedback!What is your feedback?OtherHelpfulReport an ErrorSubmit
Was this page helpful?
Thanks for your feedback!
What is your feedback?OtherHelpfulReport an ErrorSubmit
What is your feedback?
