| | Cancer | Pancreatic Cancer
Large Gallstones and Gallbladder Mass: Risks, Complications, and Management
Clinical Concern
Gallstones >2.5 cm ("quarter-sized") plus a gallbladder mass raise high suspicion for complications and possible malignancy.
Major Risks
- Bile duct obstruction: Pain, jaundice, cholangitis, pancreatitis.
- Acute cholecystitis: Inflammation, infection, risk of perforation/sepsis.
- Organ invasion: Mass may compress/invade liver, duodenum, colon.
- Gallbladder cancer: Large stones and mass are risk factors; requires exclusion.
Evaluation
- Ultrasound → CT/MRI for staging.
- Liver function tests, tumor markers (CA 19-9, CEA).
- EUS with fine-needle aspiration if mass suspicious.
Treatment
- Cholecystectomy (laparoscopic or open) for symptomatic stones/cholecystitis.
- If cancer suspected/confirmed: radical resection ± adjuvant therapy.
- ERCP for bile duct stones pre- or intra-operatively.
Urgency
Prompt surgical consultation is warranted.
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