Patología aguda de la vesícula biliar en urgencias

Abstract

Acute gallbladder diseases, particularly acute cholecystitis, are among the most common surgical emergencies. In Chile, the high prevalence of gallstone disease leads to a substantial burden of emergency visits, admissions, and urgent surgery. Acute cholecystitis is usually triggered by persistent cystic duct obstruction, leading to gallbladder distension, chemical inflammation, microvascular compromise, ischemia, and secondary bacterial infection, with potential progression to empyema, gangrene, or perforation. Although less frequent, acute acalculous cholecystitis mainly affects critically ill patients and carries higher mortality. Diagnosis relies on clinical findings, systemic inflammation, and imaging, with ultrasound as the first-line modality. Current international guidelines (Tokyo Guidelines and World Society of Emergency Surgery) provide standardized diagnostic criteria, severity grading, and evidence-based management. Early laparoscopic cholecystectomy during the same hospitalization is the definitive treatment for most patients. In those with organ dysfunction or prohibitive surgical risk, gallbladder drainage is a source-control bridge to delayed surgery. This review summarizes evidence and discusses its applicability in Chile, excluding biliary pancreatitis and cholangitis.