Acute cholecystitis is closely related to biliary stasis and bacterial infection. The main causative organisms are Escherichia coli (60% to 70%), Klebsiella, anaerobic bacilli and other gram-negative bacteria, which enter the gallbladder retrogradely through the common bile duct from the intestinal tract, and in a few cases enter the liver through the portal vein system, and then flow into the gallbladder with the bile.
Chronic cholecystitis is partly the result of acute cholecystitis, but most patients do not have a history of acute attacks. About 70% of patients have stones. Due to gallstone irritation, coupled with the long-term chronic inflammation based on repeated acute attacks, can make the gallbladder atrophy or cystic fibrous tissue thickening and hypertrophy, resulting in the reduction of the cystic cavity, the loss of function. If the gallbladder duct is completely blocked by stones, inflammatory adhesions or scars, bile cannot flow into the gallbladder, and the original bile in the gallbladder, due to the gradual absorption of bile pigments, the mucous membrane is still secreting colorless, watery mucus (white bile), which can lead to the formation of choledochal cysts; when secondary infection occurs, it evolves into choledochal cystic pus.