Acute and Chronic Calculus Cholecystitis: Pathophysiology, Pain Mechanisms, and Surgical Decision-Making

Cholelithiasis is a common hepatobiliary disorder characterized by the formation of gallstones within the gallbladder.[1] Obstruction of the cystic duct by gallstones leads to cholecystitis, which may present as acute or chronic inflammation.[2] Acute calculus cholecystitis is a surgical emergency associated with severe pain, inflammation, and systemic response, whereas chronic cholecystitis represents long-standing gallstone disease with recurrent low-grade inflammation.[3] Although laparoscopic cholecystectomy is the gold standard treatment for gallstone disease, it is often deferred or avoided in acute settings due to distorted anatomy, higher complication rates, and patient instability.[4] This article elaborates the pathophysiology, clinical features, pain mechanisms, and surgical decision-making in acute and chronic calculus cholecystitis with evidence-based in-text references.