Gangrenous cholecystitis, or gangrene of the gallbladder, happens when severe inflammation due to cholecystitis leads to tissue death.

Gangrenous cholecystitis — also known as gangrenous gallbladder or GGB — can be life threatening, but prompt treatment can resolve it. It can happen if a person does not receive early treatment for cholecystitis.

This article examines gangrenous cholecystitis, its symptoms, why it happens, and the outlook.

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Gangrenous cholecystitis is a complication of acute cholecystitis, inflammation that results when a blockage causes bile to build up in the gallbladder.

The gallbladder is a small organ that stores bile before it enters the intestine. Bile is a substance that the liver produces. It helps the body digest fat.

Cholecystitis can occur if a blockage stops bile from leaving the gallbladder. The blockage may be due to gallstones or bile sludge.

Cholecystitis can lead to inflammation and swelling. Symptoms of cholecystitis include a fever, pain, and nausea, although between 1% and 2% of people have no symptoms at this stage.

If a person does not receive treatment for cholecystitis, the gallbladder walls may thicken and become damaged. Infection and further inflammation can occur at this point. Pressure due to the blockage can lead to a loss of blood supply to the gallbladder walls. Ulceration and tissue death, or gangrene, can result. This is gangrenous cholecystitis.

If the walls become perforated, bile can leak out, leading to further complications.

According to a 2023 study, between 2% and 29.6% of people with acute cholecystitis develop gangrenous cholecystitis.

Learn more about gallbladder sludge.

Symptoms of gangrenous cholecystitis include:

Cholecystitis causes similar symptoms, but in gangrenous cholecystitis, they are more pronounced or severe.

An older person or someone with diabetes may not have symptoms. Some experts suggest that any existing damage to the peripheral nervous system may reduce their ability to notice the pain.

In severe cases, sepsis may develop. This is a life threatening condition that can rapidly become fatal. Symptoms include a fever and pain. It is a medical emergency.

Learn more about chronic cholecystitis.

Gangrenous cholecystitis can happen if a person does not receive treatment for cholecystitis or if there is a delay in treatment.

As cholecystitis progresses, the buildup of bile can start to put pressure on the gallbladder walls. As a result, blood can no longer pass through the blood vessels in this area. This can lead to tissue death, also called necrosis or gangrene.

In addition, an infection may also develop due to the presence of gas-forming organisms. This can further complicate the person’s condition.

There may be a higher risk of cholecystitis progressing to gangrenous cholecystitis if a person:

Once gangrenous cholecystitis begins, it can worsen rapidly.

Learn more about what causes cholecystitis.

If a doctor believes a person may have gangrenous cholecystitis, they will likely:

  • Consider the symptoms.
  • Ask about the person’s medical history.
  • Do a blood test.
  • Request an ultrasound, a CT scan, or both to look for swelling, thickening of the gallbladder walls, or other unusual features.

Doctors may find it difficult to distinguish between cholecystitis and gangrenous gallbladder. A doctor may only be able to confirm its presence during surgery.

Learn more about common gallbladder problems.

Treatment for gangrenous cholecystitis is usually emergency surgery to remove all or part of the gallbladder.

If a person is too unwell to undergo surgery, the medical team will work to stabilize their condition so they can undergo the procedure at another time.

For people with cholecystitis, surgery is usually a laparoscopic procedure. With prompt treatment, many people go home the day after surgery, and recovery takes about a week.

Laparoscopic surgery may also be possible for a person with gangrenous cholecystitis. However, some people may need open surgery.

Recovery may also take longer, depending on factors such as:

  • the severity of the condition
  • the person’s age and overall health
  • any complications that arise

A 2023 case study describes the treatment of a 62-year-old male with diabetes and high blood pressure who underwent surgery for a gangrenous gallbladder. This surgeon removed the affected part of the gallbladder. There were no complications — the individual needed drains for 4 days and returned home on day 5.

Learn more about treatment for cholecystitis.

Statistics suggest a fatality rate of gangrenous cholecystitis between 15% and 50%. Prompt treatment can increase the chance of a positive outcome. This usually means having surgery to remove the gallbladder within 72 to 96 hours of symptoms appearing.

Up to 25% of people experience complications, some of which can also have a severe impact.

Complications can include:

  • infection at the site of the surgery
  • lung problems
  • abscesses
  • fistulas
  • complications due to the removal of the gallbladder, if that was necessary
  • complications that can arise due to other conditions that can occur alongside cholecystitis, such as kidney problems or cardiovascular disease

The person’s age and overall health status will affect the chances of a full recovery.

There is a risk of injury to the bile duct during surgery if severe inflammation is present. This can also reduce the chance of a positive outcome.

Learn more about gallbladder removal.

Here are some questions people often ask about gangrenous cholecystitis.

What is the survival rate of a gangrenous gallbladder?

Statistics suggest that between 20% and 50% of cases are fatal. However, this will depend on how severe the condition is, how soon a person receives treatment, and individual factors. The longer it takes to access treatment, the higher the risk.

What is the difference between cholecystitis and gangrenous cholecystitis?

Cholecystitis is when a blockage causes bile to collect in the gallbladder. It can lead to pain and nausea. Sometimes, a doctor may recommend dietary changes, but many people need surgery.

In 2% to 29.6% of people, cholecystitis can progress to gangrenous cholecystitis. Infection and a loss of blood supply to the gallbladder wall lead to tissue death and other complications.

Can a gangrenous gallbladder be removed laparoscopically?

A surgeon can remove a gangrenous gallbladder through laparoscopic surgery, but it will depend on the individual case.

Gangrenous cholecystitis is a potentially life threatening complication of cholecystitis. The symptoms are similar to those of cholecystitis but tend to be more severe.

A person with this condition will likely need emergency surgery to remove all or part of the gallbladder. While many people make a full recovery, gangrenous cholecystitis can be fatal, especially without prompt treatment.