Timing of Acute Cholecystectomy in the Emergency Department Patient with Acute Cholecystitis

Position Statement
Current evidence suggests that patients with acute cholecystitis who are under 70 years of age and without risk factors should undergo early cholecystectomy during their initial hospital stay, preferably within 24-48 hours after onset of symptoms.

Acute cholecystitis (AC) is an acute inflammation of the gallbladder. In the US, gallstones are present in over 90% of cases of AC. In the remaining 5-10% of cases, gallstones are not identified, and hence referred to as “acalculous cholecystitis”. (1). Choledocholithiasis is defined as the presence of gallstones in the bile duct. In these cases, an ERCP (Endoscopic Retrograde Cholangiopancreatography) is performed to cut the sphincter connecting the common bile duct to the duodenum, to allow the stone to pass into the intestine, relieving the obstruction. Cholecystectomy currently remains the standard treatment for AC. There has been a lot of controversy about the timing of cholecystectomy. This paper addresses previous recommendations, and the most current recommendations

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