What are possible complications of biliary colic and acute cholecystitis?

Updated: Jan 18, 2017
  • Author: Peter A D Steel, MBBS, MA; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Gallbladder gangrene can be a complication in up to 20% of cases of cholecystitis and usually occurs in diabetics, the elderly, or immunocompromised persons.

Complications of cholecystitis and/or biliary colic may also include cholangitis, sepsis, pancreatitis, hepatitis, and choledocholithiasis (10%). In addition, Gallbladder perforation occurs in 10% of patients with cholecystitis. When perforation is localized, it may be seen as pericholecystic fluid by ultrasonography. Abscess formation is common. Free perforation also can occur, releasing bile and inflammatory matter intraperitoneally, causing peritonitis.

When perforation occurs next to a hollow viscus, a gallbladder enteric fistula can be formed; fistulas into the duodenum are most common. When gallstones are passed directly through the fistula into the small bowel, if they are greater than 2.5 cm, they can obstruct the ileocecal valve, which causes gallstone ileus. Mortality in these cases can be up to 20%, because the diagnosis is difficult. Treatment includes cholecystectomy, common bile duct exploration, and closure of the fistulous tract.

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