Complications of gallstones

Inflammation of the gallbladder (cholecystitis) is a possible complication of gallstones. That can develop if a stone is stopping the bile from draining out of the gallbladder. The fluid builds up and stretches the gallbladder wall, irritating the lining of the wall. Bacteria can easily grow on the inflamed lining.

The signs of an acute inflammation of the gallbladder 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. Cholecystitis can occur suddenly or develop slowly.

Acute inflammation of the gallbladder can go away by itself, but it can also lead to complications, especially if not treated. 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 is life-threatening and 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.

Gallbladder inflammations are initially treated with antibiotics and painkillers in hospital. Until the acute inflammation has gone away, you can't eat or drink anything, or only a small amount. You are put on a drip to make sure that your body gets enough fluids.

Immediate removal of the gallbladder (within one day) is recommended in case of gallbladder inflammation in order to stop the symptoms from coming back and prevent complications. If the inflammation is mild, surgery is sometimes not needed and you can wait to see if it goes away again. But that increases the risk of severe complications. New inflammations can develop that then require emergency surgery.

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

There is then a particular risk of pancreatitis or sepsis (blood poisoning). That is why the gallstones are removed from the bile ducts as quickly as possible. A procedure called endoscopic retrograde cholangiopancreatography (ERCP) is typically used. You have to lie under an x-ray machine. An endoscope is gently pushed through your mouth, stomach and small intestine to reach the bile ducts. A contrast agent is then injected so that the doctors can see your bile ducts on the x-rays. You will also be given painkillers and antibiotics. You will have a sedative (short anesthetic) before the procedure.

Gallbladder inflammation can spread to the pancreas. That 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 the flow from the pancreas, too. That can cause pancreatitis with severe pain in the upper abdomen, nausea, vomiting, and fever. You should seek urgent medical attention if you have these symptoms.

Pancreatitis often goes away on its own. But it can also spread to other organs and then be dangerous. 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) only slightly increase the risk of gallbladder cancer and bile duct cancer. It is estimated that 5 out of 1,000 people with gallstones get gallbladder cancer.

The risk of cancer is increased with very large gallstones. It is best to talk to your treating doctors about whether that might be a reason to remove the gallbladder as a precaution. Given the risks of surgery, it is important to weigh the pros and cons.

Surgery might also be an option for people with porcelain gallbladder, because a certain type of porcelain gallbladder with patchy calcifications increases the risk of cancer of the gallbladder: It is estimated that 70 out of 1,000 people with this kind of porcelain gallbladder get gallbladder cancer. Surgical removal of the gallbladder is usually recommended as a preventive measure.