Introduction 

Cholecystitis (ko-luh-sis-TIE-tis) is the inflammation of the gallbladder, which is a result of the blockage of the cystic duct that is responsible for the passage of bile from the gallbladder into the duodenum (a part of the small intestine) to help digestion.¹ The blockage can be caused by gallstones, infections and other factors, with gallstones accounting for 90% of chronic cholecystitis cases.² 

Types of cholecystitis 

Acute cholecystitis

It is an inflammation of the gallbladder associated with severe pains. This is the most common type of cholecystitis, with studies showing that 90%-95% of all cases are due to the formation of stones in the gallbladder.³ 

Chronic cholecystitis

This is a prolonged inflammation of the gallbladder arising from difficulty emptying the gallbladder's content, possibly due to mechanical or functional problems.²  

The subtypes of cholecystitis are based on the causes of the inflammation of the organ. They include: 

• Acalculous cholecystitis: the inflammation of the gallbladder is caused by factors other than gallstones, such as tumours, sepsis, dehydration, malnutrition, etc. Studies show that this accounts for 5% to 10% of all cholecystitis.^1,2
• Calculous cholecystitis: this type of cholecystitis is caused by gallstones, and accounts for about 90% of cases. Gallstones block the cystic duct in the gallbladder that is responsible for the draining out of biles.¹

Causes of cholecystitis

Several studies show different causes of gallbladder inflammations, which, if not treated, may lead to complications and potentially be lethal. These causes included:

• Gallstones 
• Tumour
• Infection 
• Biliary sludge 
• Trauma 

Symptoms of cholecystitis

Cholecystitis can present with many symptoms consistent with infection. These symptoms include:⁴

• Sudden severe pains in the upper right part of the stomach/abdomen
• High body temperature (fever)
• Nausea and vomiting
• Jaundice (yellowing of the eyes and skin)
• Bloating of the stomach

Causes of cholecystitis in pregnancy 

Hormonal changes

There is an increase in the formation of new hormones and sex steroids with an increase in oestrogen levels during pregnancy, causing high production of cholesterol and low release of bile from the gallbladder, leading to the formation of gallstones.^5,6 

Changes in gallbladder function

The increase in the volume of the uterus (womb) exerts pressure on the gallbladder, which affects bile emptying and promotes the development of gallstones.

Gallstones 

About 8% of pregnant assigned female at birth (AFAB) people develop gallstones in their third trimester. The formation of the gallstones blocks the cystic ducts, which prevent the release of bile into the small intestines, thereby causing inflammation of the gallbladder.⁵ 

Infection/sepsis

This is especially common in pregnant AFAB people with weak immunity.⁷

Risk factors of cholecystitis

Listed below are possible risk factors for cholecystitis:

• Excess weight gain
• Rapid weight loss
• Pregnancy 
• Advancing in age
• Female sex at birth
• Race 

Complications faced by pregnant people

The complications faced by both pregnant people and their foetus (unborn baby) can be life-threatening. Studies have mapped out several complications associated with cholecystitis in pregnancy, including:^8,9

• Gallbladder suppuration
• Perforation of the gallbladder
• Cholangitis
• Acute pancreatitis
• Infectious shock
• Premature delivery

Treatment of cholecystitis in pregnancy

Conservative treatment

This form of treatment is frequently recommended in the management of acute cholecystitis. This involves the use of medications and the monitoring of complications in pregnant people.⁹

Surgical interventions

The laparoscopic cholecystectomy is regarded as the gold standard for treating acute cholecystitis in pregnant people. Laparoscopic cholecystectomy is an invasive surgical procedure employed in the removal of inflamed/diseased gallbladder. It is indicated for use in the treatment of acute or chronic cholecystitis, symptomatic cholelithiasis, acalculous cholecystitis, gallstone pancreatitis and gallbladder masses. However, this procedure has associated risks such as preterm delivery and foetal hypoxia due to the use of carbon dioxide within the peritoneal cavity.⁹

Frequently asked questions (FAQ)

Can cholecystitis be diagnosed during pregnancy? 

Yes, cholecystitis can be diagnosed during pregnancy.

How can cholecystitis be diagnosed?

There are several ways to diagnose cholecystitis. They include: physical examinations, blood tests (such as complete blood count and liver function tests) and imaging tests (such as ultrasound and CT scans).¹⁰ 

Summary

Cholecystitis is a condition that is as a result of the inflammation of the gallbladder, which may be due to the formation of gallstones that block the cystic ducts, or other factors like infections or tumours. In pregnant AFAB people, cholecystitis can be treated and managed to avoid uncomfortable, or even potentially deadly complications for both the parent and foetus, such as preterm delivery or acute pancreatitis.