Complications of gallstones

The gallbladder might become inflamed if a gallstone prevents bile from draining properly. The fluid builds up and stretches the gallbladder wall, irritating the lining of the wall. Bacteria can easily grow on the irritated, inflamed lining. The signs of an acute inflammation include persistent, severe pain in the right upper abdomen, fever and chills. The right upper abdomen hurts when touched, and feels tight. The pain sometimes radiates into the right shoulder too. Inflammation of the gallbladder may be acute or chronic, or clear up on its own and then come back again.

An acute inflammation may lead to further complications, particularly if left untreated. For instance, pus might form inside the gallbladder, parts of the organ could die, or the inflammation may spread to nearby organs. If the inflammation spreads to the blood and then to the entire body, it is called sepsis. Sepsis has to be treated immediately.

In very rare cases, a chronic inflammation may lead to what is known as "porcelain gallbladder," with a thickened and calcified gallbladder wall. Then the gallbladder can no longer contract (squeeze out bile) properly. A certain type of porcelain gallbladder with patchy calcifications increases the risk of getting cancer of the gallbladder: It is estimated that 7 out of 100 people with this kind of porcelain gallbladder get gallbladder cancer.

Inflammation of the bile duct also leads to severe pain in the upper abdomen, fever and chills, and sometimes to jaundice too. Like a gallbladder inflammation, it can spread to nearby organs and lead to complications, some of them severe.

Pancreatitis is often caused by bile duct stones that get stuck in front of the opening to the duodenum (the first part of the small intestine). Because the opening of the bile duct joins the opening of the pancreatic duct here, these trapped stones can stop pancreatic juice from flowing out of the pancreas too. That increases the risk of pancreatitis. The inflammation in the pancreas leads to severe pain in the upper abdomen, as well as nausea, vomiting and fever.

Pancreatitis often goes away on its own. But it can become life-threatening if the inflammation spreads to other organs. Because of this, people who are thought to have pancreatitis need to go to hospital and stay there for a while.

Gallstones or gallbladder polyps (growths that stick out of the lining of the gallbladder) can increase the risk of gallbladder cancer and bile duct cancer – but usually only slightly. It is estimated that 5 out of 1,000 people with gallstones get gallbladder cancer.

Although large gallstones increase the risk of cancer somewhat, there's no reason to remove the gallbladder if the stones aren't causing any symptoms – with a few exceptions.

Things are different in people who have a (very rare) porcelain gallbladder. Their risk of cancer is especially high. Because of this, they are advised to have their gallbladder removed to prevent cancer. Cancer develops in half of all people with porcelain gallbladder who don't have their gallbladder removed.

In Germany, a total of about 5,000 people get gallbladder cancer or bile duct cancer each year.