Complications of gallstones

Photo of a man holding his belly in pain

Many people over the age of 40 have gallstones. But most of them don’t realize it because the stones don’t cause any problems. People who have symptoms such as colic also have an increased risk of complications.

The possible complications of gallstones include of the gallbladder, bile duct or . An obstruction (blockage) of the bowel is rare. Very large gallstones can increase the risk of gallbladder cancer and bile duct cancer. Each year, complications occur in about 2 out of 100 people who have typical gallbladder symptoms such as colic. That is why treatment can be a good idea if you have symptoms.

Inflammation of the gallbladder

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 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 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 may spread to nearby organs. If the 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 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.

How are gallbladder inflammations treated?

Gallbladder inflammations are initially treated with and painkillers in hospital. Until the acute 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 in order to stop the symptoms from coming back and prevent complications. If the 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.

Acute inflammation of the bile duct

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 , 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 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 . You will have a sedative (short anesthetic) before the procedure.

Inflammation of the pancreas

Gallbladder can spread to the . 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.

Gallbladder cancer and bile duct cancer

Gallstones or gallbladder (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.

Borzellino G, Khuri S, Pisano M et al. Timing of early laparoscopic cholecystectomy for acute calculous cholecystitis: a meta-analysis of randomized clinical trials. World J Emerg Surg 2021; 16(1): 16.

Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselerkrankungen (DGVS), Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV). Prävention, Diagnostik und Therapie von Gallensteinen (S3-Leitlinie, in Überarbeitung). AWMF-Registernr.: 021-008. 2017.

Gurusamy KS, Davidson C, Gluud C et al. Early versus delayed laparoscopic cholecystectomy for people with acute cholecystitis. Cochrane Database Syst Rev 2013; (6): CD005440.

Gutt C, Schlafer S, Lammert F. The Treatment of Gallstone Disease. Dtsch Arztebl Int 2020; 117(9): 148-158.

Robert Koch-Institut (RKI). Krebs in Deutschland 2017/2018. Berlin: RKI; 2021.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Updated on July 18, 2023

Next planned update: 2026


Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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