Gallbladder: Gallstone Complications
Majority of patients with gallstones have no symptoms. In such patients, no treatment is required. Symptomatic gallstones diease in the early stages can be easily treated. However, gallstone disease can lead to potentially serious complications affecting multiple organs.
When the gallstone gets stuck in the opening of the gallbladder, it will become distended and inflamed as bile is not able to flow out.
• Constant severe pain in the right upper abdomen
• Nausea and vomiting
• Deep breathing may worsen the pain
This is a surgical emergency, and urgent medical attention is needed.
Due to the obstruction of the gallbladder outlet by the gallstone, the fluid that is trapped within the gallbladder can become infected. This can lead to pus and fluid collecting within the gallbladder. Bacteria can enter the blood stream causing blood poisoning (septicaemia).
The distended and inflamed gallbladder can burst through its wall. This can lead to serious infective and metabolic complications from the spillage of bile into the body cavity.
The common bile duct is the main channel for bile flow between the liver and the small intestine.
Common bile duct stones are gallstones which have moved from the gallbladder into the common bile duct and obstruct the flow of bile from the liver into the small intestine. Bile then accumulates in the patient’s blood, giving rise to:
• Tea-coloured urine
• Clay-coloured faeces
• Generalised itch
• Liver failure (biliary cirrhosis)
• Cholangitis (infected bile in the common bile duct)
Common bile duct stones need to be removed, even if the patient does not have any symptoms.
Removal of common bile duct stones can be done:
• Surgically (common bile duct exploration)
- Laparoscopic Common Bile Duct Exploration (keyhole technique)
- Traditional Open Common Bile Duct Exploration
• Endoscopically (Endoscopic Retrograde Cholangio-Pancreatography (ERCP))
Bacteria may enter an obstructed common bile duct and cause an infection of the obstructed system leading to pus in the bile duct. This is a potentially life-threatening infection.
• Severe abdominal pain
• High fever with rigors (shivering)
Infection may spread into the liver, causing liver abscesses. If treatment is delayed, the infection may spread into the blood stream, causing blood poisoning (septicaemia). Multi-organ failure and death can occur.
This condition needs urgent medical attention. The patient may need to be admitted into the High Dependency Unit or Intensive Care Unit (ICU) for stabilization.
Emergency drainage of the bile duct is needed to decompress the system via:
• Endoscopic Retrograde Cholangio-Pancreatography (ERCP)
• Percutaneous Transhepatic Cholangiography (PTC)
- catheter inserted into the bile duct under X-ray or ultrasound guidance
In a very sick patient, the doctor may have to wait till the patient stabilises and improves, before planning a second procedure to manage the common bile duct stones.
The common bile duct stone may obstruct the flow of enzymes from the pancreas into the intestine. The backflow of enzymes into the pancreas causes acute pancreatitis.
• Severe constant pain in the upper abdomen often radiating to the back
In rare circumstances, the gallstones can cause chronic irritation and inflammation of the gallbladder such that the gallbladder undergoes malignant change and turns cancerous. It has been observed that this is more common with large stones that are more than 3cm in diameter.
In rare circumstances, the gallstone may erode through the wall of the gallbladder into the adjacent intestine, either the colon or the duodenum. As it travels down the intestine, it may become stuck within the intestine, causing a severe form of intestinal obstruction. The patient will complain of severe intermittent abdominal pain associated with abdominal distension. It is often accompanied by vomiting. Surgery is required to treat this condition.