Acute cholecystitis at ER—We can remove it!

The optimal management of patients suffering from acute cholecystitis presenting in the emergency room is cholecystectomy, preferably laparoscopic. However, the operation mandates a general anesthesia, and some patients are considered to be at high risk for the procedure. However, cholecystectomy is not without complications, among which inadvertent bile duct injury is the most serious, because it can be a cause of mortality. Alternatively, the patient can be managed conservatively with or without drainage procedures, either interventional radiologic or endoscopic, and cholecystectomy can be delayed after the risk factors are corrected or acute inflammation has subsided. The best timing and sequence of treatment remain to be determined and will be discussed briefly, mainly from a surgical point of view.