Ischaemic cholecystitis and infarction of the gallbladder.

The clinicopathological features of forty three patients with gallbladder disease are presented where ischaemia appeared to be the primary aetiological factor. Histopathological changes of severe ischaemia (ischaemic cholecystitis) were present in 16 patients and of infarction of the gallbladder in the remaining 27 patients. All patients with ischaemic 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 eight patients with infarction of the gallbladder had a thin walled gallbladder without serosal reaction. Only two of these patients had gallbladders that contained calculi. The pathogenesis of thick walled ischaemic 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 ischaemic 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.