A problem always confronting the internist and the surgeon is the diagnosis of cholecystitis without stones. The symptoms of noncalculous cholecystitis are by no means clearcut and definite. The classic description portrays a patient, usually female and obese, suffering from episgastric distress, gas, belching, nausea and pain in the upper part of the abdomen. Constipation is a prominent complaint and, if the symptoms enumerated are present, it is rarely absent. Acute pain or colic is a rare complaint and in the vast majority of cases indicates the presence of stones or an acute infection in the gallbladder. Cholecystography is admittedly a great help and in most cases should be the deciding factor, but there is marked variation in the interpretation of cholecystograms. Much significance has been placed on the finding of delayed emptying and poor visualization of the gallbladder. Visualization depends on many variables besides the function of the gallbladder
WILKINSON SA. CHRONIC CHOLECYSTITIS VERSUS IRRITABLE COLON. JAMA. 1937;109(13):1012–1016. doi:10.1001/jama.1937.02780390014007
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