Acute cholecystitis (Acute Cholecystitis) is an inflammation of the gallbladder caused by obstruction of the gallbladder duct and bacterial attack, and is one of the most common surgical emergencies. It is the second most common surgical emergency abdominal disease after acute appendicitis. About 95% of the cases are stone cholecystitis; 5% are non-stone cholecystitis; the pathogenic bacteria cause retrograde infection of the biliary tract, or the gallbladder through the blood circulation or lymphatic route, causing infection when the bile flows poorly. Common causative organisms: Gram-negative bacteria, Escherichia coli is the most common, other Klebsiella, Enterococcus faecalis, Pseudomonas aeruginosa, etc.; often combined with anaerobic bacterial infections. Acute cholecystitis clinicopathological stages: 1, acute simple cholecystitis,: due to obstruction of the gallbladder duct, mucosal edema, congestion, increased exudation in the gallbladder, enlargement of the gallbladder. 2, purulent cholecystitis: if the inflammation spreads to the whole gallbladder, the gallbladder is filled with pus, and there is also purulent fibrinous exudation on the plasma membrane surface. 3, gangrenous cholecystitis: the obstruction of the gallbladder duct is not lifted, the pressure in the gallbladder continues to rise, the blood supply to the gallbladder wall is impaired, and there is ischemic necrosis. Clinical manifestations: 1. Acute phase: epigastric distension – paroxysmal colic; common at night, triggered by full meals and greasy food; pain radiates to the right shoulder, scapula and back, accompanied by nausea, vomiting, anorexia, constipation and other gastrointestinal symptoms. 2. Progressive stage: pain is persistent and paroxysmally increasing, accompanied by mild to moderate fever, aversion to fever, and no chills. 3, gallbladder gangrene, perforation or pus accumulation, combined with acute cholangitis: chills, high fever, mild jaundice in 10%-20% of patients Physical examination: pressure pain in the right upper abdominal gallbladder area, rebound pain and muscle tension may occur when inflammation spreads to the plasma membrane layer, and Murphy’s sign is positive. Sometimes an enlarged gallbladder is palpated with tenderness. If the large omentum is wrapped, a mass with indistinct borders and fixed pressure pain is formed. If the gallbladder is gangrenous and perforated, diffuse peritonitis manifests. Ancillary tests: 1, laboratory tests: 85% of blood leukocytes and neutrophils are elevated, special for the elderly, often with elevated serum alanine transferase and alkaline phosphatase; 1/2 patients have elevated serum bilirubin and 1/3 patients have elevated serum amylase. 2.Ultrasound: enlarged gallbladder, thick wall (>4mm), “bilateral sign” will appear when edema is obvious; when combined with stones, it shows strong echogenicity followed by acoustic shadow. The accuracy rate is 85%~95%. 3.CT and MR examination can help to diagnose. 4.Radionuclide imaging: in patients with atypical symptoms, the sensitivity is 97% and the specificity is 87%, such as gallbladder imaging, 95% of patients can exclude acute cholecystitis. Conservative treatment: 1, non-surgical treatment: fasting, fluid infusion, vitamin supplementation, nutritional support, correction of water, electrolyte and acid-base metabolic imbalance. 2, anti-infection: use antibiotics and combination of drugs effective against gram-negative bacteria and anaerobic bacteria. 3, antispasmodic and analgesic, anti-inflammatory and biliary drugs. 4, elderly patients, monitoring blood pressure, blood sugar and heart, lung, kidney and other organ functions, treatment of complications. Surgical treatment: 1. Indications for emergency surgery: (1) those with onset within 48 to 72 hours; (2) those who have failed conservative treatment or whose condition has deteriorated; (3) those with gallbladder perforation, diffuse peritonitis, or complications such as acute suppurative cholangitis or acute gangrenous pancreatitis. 2. Surgical methods: (1) laparoscopic cholecystectomy or open cholecystectomy is preferred; (2) laparoscopic combined with choledochoscopic biliary stone extraction according to the contractile function of the gallbladder and the patient’s desire for biliary preservation; (3) PTGD (color ultrasound-guided percutaneous transhepatic cholecystocentesis and drainage): the pressure in the gallbladder can be reduced, and then operated electively after the acute period. It is suitable for patients with septic cholecystitis who are critically ill and not suitable for surgery.