When the gallbladder wall becomes inflamed and fibrotic, the gallbladder is contracted, which is known as chronic non-lithotripsy cholecystitis. What are the causes of chronic non-lithotripsy cholecystitis? Chronic non-lithiatic cholecystitis is the most common type of gallbladder disease. Patients usually have gallstones at the same time, but patients with chronic cholecystitis without stones are not uncommon in China. Chronic non-lithotripsy cholecystitis can sometimes be a sequel to acute cholecystitis, but most patients have not had acute cholecystitis in the past. Due to long-term inflammation of the gallbladder, the gallbladder wall can become fibrous thickened and scarred, resulting in gallbladder atrophy and complete closure of the cystic cavity, leading to decreased or even complete loss of gallbladder function. Chronic non-lithiatic cholecystitis often develops from acute cholecystitis or starts as a chronic process. After several episodes or long-term chronic inflammation, the mucosa is destroyed, with polyp-like changes, thickening of the gallbladder wall, fibrosis, chronic inflammatory cell infiltration, muscle fiber atrophy, loss of gallbladder function, and in severe cases, the gallbladder atrophy becomes smaller, the gallbladder cavity shrinks, or is filled with stones, forming the so-called atrophic cholecystitis. The symptoms and signs of chronic non-lithotripsy cholecystitis are atypical. Most of the symptoms are biliary dyspepsia, aversion to greasy food, epigastric distention, belching, stomach burning, etc., similar to ulcer disease or chronic appendicitis; sometimes acute attacks may occur due to stone obstruction of the gallbladder duct, but when the stone moves and the obstruction is removed, it rapidly improves. On physical examination, there may be mild pressure pain or percussion pain in the gallbladder area; if the gallbladder is fluid, a round, smooth cystic mass can often be found. Chronic non-stone cholecystitis may present with right upper abdominal distension and pain, increased pain with postural changes and breathing, radiating pain in the right shoulder or back, high fever, chills, and nausea and vomiting. In chronic cholecystitis, dyspepsia, epigastric discomfort or dull pain, nausea, abdominal distention and belching may be present and may be aggravated by eating fatty foods.