Emergency Gallbladder Surgery

When is emergency gallbladder surgery needed?

The procedure becomes necessary when gallbladder disease progresses rapidly or becomes unstable. These situations can put stress on the body and create dangerous infections that spread beyond the gallbladder.

Some of the common reasons include:

• Gallstones blocking the ducts – stones can obstruct the outflow of bile, rapidly triggering inflammation, infection or pressure buildup.
• Acute cholecystitis (sudden inflammation) – this occurs when a gallstone blocks the cystic duct, causing swelling, rising pressure and bacterial infection that cannot wait for scheduled treatment.
• Gallbladder empyema (pus inside the gallbladder) – severe infections can cause the gallbladder to fill with pus, increasing the risk of rupture or sepsis unless treated urgently.
• Gangrenous gallbladder – poor blood flow can cause parts of the gallbladder to die, which can rupture and lead to life-threatening complications.
• Gallbladder perforation – a burst gallbladder leaks bile and infection into the abdomen, requiring immediate surgery to prevent widespread inflammation (peritonitis).
• Severe biliary colic unresponsive to pain relief – when pain becomes persistent or keeps returning, it may signal that the gallbladder is unstable and at risk of complications.
• Bile duct stones with infection (cholangitis) – blocked bile flow can cause high fever, jaundice and severe infection that may require urgent intervention.

Additionally, emergency issues can also develop from unrelated factors such as:

• Bacterial infections – infections can occur when bile becomes stagnant or when the gallbladder is obstructed.
• Blood supply compromise – poor blood flow can lead to gangrene, which progresses quickly and is highly dangerous.
• Trauma or injury to the abdomen – although rare, blunt trauma can damage the gallbladder and require emergency care.

What are the risks of delaying emergency gallbladder surgery?

When the gallbladder becomes unstable or infected, delaying surgery can lead to serious complications. This includes:

• Abscess formation – pockets of pus may form around the gallbladder, making surgery more complex and recovery longer.
• Infection – infection spreading through the abdomen can damage multiple organs and significantly increase risks.
• Perforation (burst gallbladder) – a rupture releases bile and infection into the abdomen, causing life-threatening inflammation.
• Sepsis (bloodstream infection) – severe infections can spread quickly and overwhelm the body, requiring intensive care.
• Worsening pain and instability – the condition may become harder to treat as inflammation progresses.

How does emergency gallbladder surgery work?

Although the situation may feel urgent or overwhelming, emergency gallbladder surgery follows a structured and careful process. Dr Aaron Poh’s goal is always the same, which is to stabilise the patient, remove the source of infection or blockage and restore safety as quickly as possible.

The process typically involves:

• Anaesthesia – general anaesthesia is given to ensure the patient sleeps comfortably throughout the operation. This also allows the surgeon to work without the patient feeling pain or discomfort, which is especially important when the gallbladder is severely inflamed.
• Laparoscopic removal – whenever safely possible, keyhole (laparoscopic) surgery is performed. Several small incisions are made and a camera is inserted to provide a clear, magnified view of the gallbladder. Special instruments are used to detach and remove the inflamed or infected gallbladder with minimal disruption to surrounding organs.
• Conversion to open surgery if necessary – in emergency cases, the anatomy may be distorted by swelling, infection or scarring. If the surgeon determines that visibility or safety is compromised, the procedure may be converted to an open approach. This involves making a larger incision to gain better access and full control, which is a decision made only to protect the patient and ensure a safe outcome.

Removal of infected fluids – the surgeon then washes out any pus, bile leakage or infected fluid within the abdomen. Clearing these pockets reduces the risk of persistent infection or complications later, helping the body recover more smoothly after surgery.

Can a scheduled gallbladder surgery become an emergency surgery?

Yes, a planned gallbladder removal can sometimes turn into an emergency if symptoms suddenly worsen. Even patients with mild or intermittent gallstone issues can experience sudden blockage or infection.

Situations where elective surgery becomes urgent include:

• Sudden severe pain that does not settle – this may indicate acute inflammation or a stone becoming lodged in the duct.
• Fever and chills – these symptoms show infection, which requires prompt intervention.
• Jaundice appearing suddenly – this suggests bile duct obstruction, which can progress quickly into cholangitis.
• Vomiting and inability to eat or drink – these signs indicate that the condition has escalated and may no longer be safe to wait.
• Imaging showing high-risk features – tests may reveal thickened gallbladder walls, fluid collections or large impacted stones.