Gallstones: complications
Most people with gallstones never have a serious complication. However, if the gallstones are not treated, they can cause jaundice (a yellow discolouration of the skin and whites of the eyes), pancreatitis or infections in the gallbladder or bile duct in some people.
Some of the complications relating to gallstones include inflammation of the gallbladder (cholecystitis), inflammation of the bile duct (cholangitis), inflammation of the pancreas (biliary pancreatitis), and obstruction of the intestine (gallstone ileus).
Acute cholecystitis (sudden inflammation of the gallbladder)
Acute cholecystitis (inflammation of the gallbladder) is a condition indicated by a sudden attack of pain in the upper abdomen that lasts more than 12 hours. It may be triggered by a large meal or a meal with fatty foods. Nausea and vomiting may also occur. It is often accompanied by a high fever. If you have this condition you are likely to be hospitalised and treated with quick-acting formulations of pain relievers, usually by injection. The inflammation is not always due to infection, but if secondary infection is present, you may also be prescribed a broad-spectrum antibiotic. Fluids are usually given intravenously, and your stomach kept empty by suctioning to reduce stimulation of your gallbladder, until the inflammation has subsided.
Acute cholecystitis is distinguished from biliary colic, which is the pain caused when gallstones obstruct the gallbladder but no inflammation is present. This pain tends to be less sharp, there is no fever, and the abdomen is less exquisitely tender.
It is usual for the gallbladder to be removed once your condition has stabilised, in order to avoid further pain and complications, and to reduce the chance of readmission.
Chronic cholecystitis
Repeated attacks of acute cholecystitis can damage the gallbladder and result in chronic cholecystitis (long-lasting gallbladder inflammation). Chronic cholecystitis is more common in women. Symptoms include episodes of upper abdominal pain, often accompanied by nausea or vomiting. Belching and bloating are common, and the symptoms may be brought on by fatty or large meals.
While avoiding fatty foods may reduce the frequency of episodes, surgery to remove the gallbladder is usually required to treat chronic cholecystitis.
Acute cholangitis
Cholangitis (inflammation of the bile ducts) may occur if your bile ducts become blocked and subsequently infected with bacteria from the small intestine. This is a serious condition requiring urgent treatment. If not treated with antibiotics and a procedure to unblock the ducts, fever, abdominal pain and jaundice will develop and death can result. The bile ducts may be unblocked by the insertion of a tube (stenting) or through surgical drainage.
Acute biliary pancreatitis
Pancreatitis (inflammation of the pancreas) is a potentially serious disorder that occasionally develops in people with gallstones. It is more common in people with numerous small stones, and occurs when gallstones passing through the common bile duct temporarily obstruct the duct leading from the pancreas (pancreatic duct). The pancreas is an organ that produces digestive enzymes and hormones such as insulin. This complication requires urgent hospitalisation, and is treated with techniques known as endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy. The techniques involve visualising any blockages with dye and then making a cut to release any stones causing the blockage.
Gallstone ileus
Gallstone ileus is a condition where gallstones obstruct the small or large intestine. Gallstone ileus can happen when an inflamed gallbladder becomes stuck to the intestine, and the gallstones erode their way through the gallbladder wall and into the intestine where they cause a blockage. The treatment for this is urgent surgery.
Obstructive jaundice or cholestasis
Obstructive jaundice is jaundice resulting from bile not being able to flow, causing yellowing of the skin and eyes due to build up of bile pigments (bilirubin). The bile ducts may be blocked by a stone, a tumour or a narrowing (stricture).
Cholestasis is the word doctors use for a reduction in flow or stoppage in the flow of bile. Because the bile cannot flow freely, it backs up in the bloodstream. The urine may become dark because the kidneys try to pass the extra bilirubin, while the faeces may become pale because they have no bilirubin to give them colour.
Your doctor may suggest you have an ultrasound scan so that they can see whether there are stones blocking the ducts or if there is a tumour causing the blockage. If you have stones blocking bile ducts, surgery will normally be required to unblock the ducts. This may be via endoscopy.
Narrowing of the bile duct (a stricture) may happen after surgery has been carried out to remove the gallbladder (a cholecystectomy). It will usually be treated by inserting a stent to push back the narrowed walls of the duct.
Tumours that block the bile duct include cancers of the pancreas or gallbladder.
Gallbladder cancer
Having gallstones can increase the risk of developing gallbladder cancer, but this type of cancer is rare — most people with gallstones never develop gallbladder cancer.
Last Reviewed: 03 July 2009
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