Complications

• Cholecystitis

  • Acute cholecystitis (most common)

  • Chronic cholecystitis

  • Porcelain gallbladder

• Choledocholithiasis

• Acute cholangitis

• Acute biliary pancreatitis

• Biliary-enteric fistula: Cholecystoenteric/choledochoenteric fistula (rare) , which can cause gallstone ileus (rare)

extrinsic compression of the common bile duct (or any extrahepatic bile duct) by gallstone(s) impacted in the cystic duct or the infundibulum of the gallbladder

• Clinical features: similar to choledocholithiasis

• Diagnostics: preferably ERCP/MRCP

  • Narrowing of the common hepatic duct

  • Stone within the cystic duct

  • Dilation of the intrahepatic biliary tree

• Treatment

  • ERCP-guided CBD stent placement may be considered preoperatively to allow for biliary drainage.

  • Open cholecystectomy may be preferred if diagnosed preoperatively.

• Complications

  • Cholecystocholedochal fistula: an abnormal communication between the gallbladder and the common bile duct

  • Cholecystoenteric/choledochoenteric fistula (biliary-enteric fistula): an abnormal communication between the gallbladder or the CBD with the adjacent bowel

  • Gallstone ileus: due to biliary-enteric fistula

• Definition: marked distention of the gallbladder with sterile mucinous content due to chronic biliary outflow obstruction

• Etiology

  • Impacted gallstone at the gallbladder neck (most common)

  • Resolved acute cholecystitis

  • Tumors at the gallbladder neck or CBD (e.g., GB polyps, cholangiocarcinoma, carcinoma of pancreatic head)

  • Acute inflammatory conditions (e.g., Kawasaki disease)

  • Extrinsic compression of the biliary outflow tract (e.g., lymphadenopathy, adhesions, strictures)

• Pathophysiology: chronic biliary outflow obstruction → resorption of bile and secretion of mucin by biliary mucosa → collection of mucinous secretion within the gallbladder with no outflow → gross distention of the gallbladder