The contemporary concept of the etiopathogenesis of acute obstructive cholecystitis and biliary hypertension

Ion Ciutac; Gheorghe Ghidirim

doi:10.52673/18570461.26.1-80.06

Authors

Ion Ciutac "Holy Trinity" Municipal Clinical Hospital https://orcid.org/0009-0000-3476-1025
Gheorghe Ghidirim Nicolae Testemițanu State University of Medicine and Pharmacy https://orcid.org/0000-0002-9047-0596

DOI:

https://doi.org/10.52673/18570461.26.1-80.06

Keywords:

acute obstructive cholecystitis (AOC), laparoscopic cholecystolithostomy (LCSL), impacted stone, inflammatory occlusion of the infundibulo-cystic orifice, increased bile viscosity

Abstract

This article presents the results of a study on the etiopathogenesis of acute obstructive calculous cholecystitis and the effectiveness of decompresive laparoscopic cholecystolithostomy tehniques used in treating patients with acute cholecystitis and cholecysto-pancreatitis in high-risk groups. The implementation of cholecystolithostomy technology with visual or endoscopic extraction of gallstones from the gallbladder, associated with intraoperative cholecystoscopy for the evaluation of the gallbladder lumen and the infundibulo-cystic junction, as well as the use of modern investigative methods, made it possible to elucidate certain pathogenetic mechanisms that have been insufficiently known until now. Three main factors involved in triggering the acute episode and in the development of intravesical hypertension were discovered: stones impacted in the gallbladder neck (mechanical factor), inflammatory occlusion of the infundibulo-cystic junction (inflammatory factor), increased bile viscosity (colloidal factor). The role and interaction of these factors in the occurrence and maintenance of increased intravesical pressure, as well as in the progression of inflammatory changes in the gallbladder wall, were demonstrated. Based on these findings, a fundamentally new etiopathogenetic concept of acute obstructive cholecystitis has been formulated, allowing for prediction of the inflammatory progression within the gallbladder and determining the necessity of applying minimally invasive decompressive laparoscopic procedures – an essential approach for high-risk patients.

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