ISCHAEMIC CHOLECYSTITIS AND INFARCTION OF THE GALLBLADDER

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Abstract
The clinicopathological features of 43 patients with gallbladder disease are presented where ischemia appeared to be the primary etiological factor. Histopathological changes of severe ischemia (ischemic cholecystitis) were present in 16 patients and of infarction of the gallbladder in the remaining 27 patients. All patients with ischemic cholecystitis and 19 of the patients with infarction of the gallbladder had a thick-walled gallbladder due to a serosal reaction and these 35 gallbladders all contained calculi. The remaining 8 patients with infarction of the gallbladder had a thin-walled gallbladder without serosal reaction. Only 2 of these patients had gallbladders that contained calculi. The pathogenesis of thick-walled ischemic cholecystitis or infarction appeared to be related to intramural vascular insufficiency which accompanies calculus disease of the gallbladder. Thin-walled infarction of the gallbladder appeared to develop as a result of extramural arterial insufficiency due to arterial disease, thrombosis or trauma. The clinical course of thick-walled ischemic gallbladder disease was not significantly different from severe acute cholecystitis with calculi. However, 75% of the patients with thin-walled infarcted gallbladders were severely ill from their associated illness or trauma and nearly all died.