Complications of gallstones

Photo of a man holding his belly in pain
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Gallstones are quite common in people over the age of 40. But most people don't notice them because the stones don't cause any symptoms. Treatment is usually only a good idea if there are noticeable symptoms. This is because that means there is a greater risk of complications.

The possible complications of gallstones include of the gallbladder, bile duct or pancreas. In rare cases they can lead to an obstruction (blockage) of the bowel. Very large gallstones may increase the risk of gallbladder cancer and bile duct cancer. Each year, complications occur in about 1 out of 100 people who have typical gallbladder symptoms such as colic.

Inflammation of the gallbladder (cholecystitis)

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 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 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 may spread to nearby organs. If the 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 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.

Acute inflammation of the bile duct (cholangitis)

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 , it can spread to nearby organs and lead to complications, some of them severe.

Inflammation of the pancreas (pancreatitis)

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 too. That increases the risk of pancreatitis. The in the 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 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.

Illustration: Location of the gallbladder

Location of the gallbladder

Gallbladder cancer and bile duct cancer

Gallstones or gallbladder (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.

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

Gurusamy KS, Davidson BR. Gallstones. BMJ 2014; 348: g2669.

Robert Koch-Institut (RKI). Krebs in Deutschland für 2015/2016. August 17, 2020.

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. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

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Updated on April 27, 2021
Next planned update: 2024

Authors/Publishers:

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

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