Acute Cholecystitis Current Evidence on Diagnosis Severity Assessment and Therapeutic Management

Abstract

This narrative review aimed to synthesize current evidence on the diagnosis, severity assessment, and management of acute cholecystitis, with emphasis on contemporary imaging strategies, early laparoscopic cholecystectomy, and alternative interventions for patients with increased operative risk. Literature was searched through PubMed/MEDLINE and Google Scholar for publications from August 2016 to August 2026 using combinations of terms related to acute cholecystitis, ultrasonography, computed tomography, magnetic resonance imaging, hepatobiliary scintigraphy, Tokyo Guidelines, severity grading, laparoscopic cholecystectomy, early cholecystectomy, gallbladder drainage, and percutaneous or endoscopic drainage. The reviewed evidence indicates that ultrasonography remains an important initial imaging modality, although its diagnostic sensitivity is moderate and may vary according to clinical and operator-related factors. Computed tomography, magnetic resonance imaging, and hepatobiliary scintigraphy provide complementary diagnostic information when ultrasonography is inconclusive or complications are suspected. Severity assessment supports clinical risk stratification but should be interpreted together with comorbidities, physiological status, and operative risk. Early laparoscopic cholecystectomy remains the principal definitive treatment for suitable surgical candidates and is associated with shorter hospitalization without a clear increase in major postoperative complications. For patients at increased operative risk or unsuitable for immediate surgery, gallbladder drainage provides an alternative source-control strategy, with endoscopic ultrasound-guided drainage representing an increasingly supported option in experienced centers. Overall, management should be individualized according to disease severity, patient risk, anatomical considerations, and available expertise.