It is common for patients to seek emergency care due to complications related to cholecystolithiasis. The risk of complications increases by 0.1% to 0.3% per year after the first episode of pain.
Furthermore, smaller stones increase the risk of pancreatitis and jaundice due to their greater ease of migration.
Among the main complications are acute cholecystitis, choledocholithiasis, cholangitis and biliary pancreatitis.
Acute cholecystitis
Acute cholecystitis represents the most common complication. It manifests when there is persistent obstruction of the cystic duct by an impacted stone, leading to bacterial translocation, colonization and subsequent inflammation.
Symptoms include abdominal pain lasting more than 6 hours, nausea, vomiting and fever. Physical examination may reveal a positive Murphy's sign.
Laboratory tests often indicate leukocytosis and elevated CRP. Changes in FA, GGT, TGO, TGP and bilirubin levels may occur.
Abdominal or liver ultrasound and magnetic resonance cholangiopancreatography (MRCP) show an impacted stone in the infundibulum that does not move with changes in position, gallbladder wall thickening (greater than 6 mm) and the presence of biliary sludge.
Treatment generally involves hydration, controlling pain and nausea with antiemetics, as well as the use of antibiotics such as amoxicillin and clavulanate or ceftriaxone/ciprofloxacin and metronidazole.
Early laparoscopic cholecystectomy, preferably within the first 72 hours, is the recommended definitive treatment.
Biliary pancreatitis
Cholelithiasis can also result in acute pancreatitis.
When a stone becomes impacted in the sphincter of Oddi, it can cause an obstruction that interrupts pancreatic flow.
Choledocolithiasis
As mentioned previously, choledocholithiasis occurs when gallstones become lodged in the common hepatic duct or common bile duct.
This condition affects approximately 10% of patients with cholecystolithiasis and can lead to obstruction of the bile ducts, resulting in cholestasis, jaundice and increasing the risk of infection.
The gallbladder becomes undetectable to the touch (sclerotic). It is common to observe an increase in the levels of alkaline phosphatase (FA) and gamma-glutamyltransferase (GGT), associated with elevations in the levels of transaminases (TGO, TGP) and bilirubin.
Although abdominal ultrasound is not able to directly visualize the common bile duct, it can reveal dilation of the common hepatic duct, indicating a possible obstruction. Magnetic resonance cholangiopancreatography (MRC) is considered the diagnostic method of choice, allowing direct visualization of dilation and obstruction.
Treatment usually involves performing endoscopic retrograde cholangiopancreatography (ERCP).
Cholangitis
Cholangitis is a complication that can arise due to choledocholithiasis, where a stone impacted in the common bile duct can lead to infections due to bacterial growth.
This infection of the biliary system is known as cholangitis and is caused by stagnation of bile, representing a serious condition with fatal potential.
Typical symptoms include fever, abdominal pain and jaundice, forming Charcot's Triad. In severe cases, these symptoms may be accompanied by hypotension and changes in the level of consciousness, configuring the Reynolds pentad, which is a sign of sepsis.
Abdominal ultrasound can reveal the presence of stones in the gallbladder, in addition to dilation of the common bile duct and intrahepatic bile ducts.
Immediate treatment aims to stabilize the patient, including hydration, pain control and supportive measures. Antibiotics such as ampicillin with sulbactam or ceftriaxone/ciprofloxacin with metronidazole are used to treat the infection.
Conclusion
Gallstone disease is a common condition that can cause severe pain and serious complications.
Symptoms often include sharp abdominal pain, nausea and vomiting.
Treatment usually involves surgical removal of the gallbladder through laparoscopic cholecystectomy, with the use of antibiotics and other measures to treat infections and associated complications.