Gallstone Complications: Obstruction, Cholecystitis, Cholangitis, Pancreatitis

Gallstones (cholelithiasis) become problematic when they obstruct biliary flow.

Major Complications

• Biliary colic: Transient cystic duct obstruction → RUQ pain, nausea; resolves spontaneously.
• Acute cholecystitis: Persistent cystic duct blockage → gallbladder inflammation/infection. Murphy's sign +, fever, leukocytosis.
• Choledocholithiasis: Stone in common bile duct → obstructive jaundice, dark urine, clay stools, pruritus.
• Ascending cholangitis: CBD obstruction + infection → Charcot's triad (fever, RUQ pain, jaundice) → Reynolds' pentad (+ hypotension, confusion). Emergency ERCP.
• Gallstone pancreatitis: Stone impacts ampulla of Vater → pancreatic duct obstruction. Severe epigastric pain radiating to back; lipase ↑↑.
• Gallstone ileus: Fistula (cholecystoduodenal) → large stone obstructs terminal ileum. Rigler's triad (pneumobilia, ectopic stone, obstruction).

Management

• Asymptomatic stones: observation.
• Symptomatic: Cholecystectomy (laparoscopic gold standard).
• CBD stones: Preoperative ERCP or intraoperative cholangiogram/LCBDE.
• Cholangitis/pancreatitis: Stabilize → ERCP → cholecystectomy.