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Multidisciplinary Management of Common Bile Duct Stones pp 113–127Cite as

Management of Medical Complications of Gallstone Disease

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Abstract

Because the biliary tree is a low-pressure pathway for excretion of hydrophobic products, bile is vulnerable to precipitation, and once they form, bile crystals or stones rarely dissolve spontaneously. Risk factors for the development of gallstones include female gender, pregnancy, multiparity, chronic hemolytic conditions, obesity, and total parenteral nutrition. Gallstone disease manifests either by obstruction or by erosion. Obstruction may be transient or complete. Obstructive gallstone disease may present as choledocholithiasis, biliary pain, acute gallstone pancreatitis, or ascending cholangitis. Acute pancreatitis is the most common gastrointestinal cause of hospital admission and is a cause of significant morbidity and mortality. Severe acute pancreatitis and ascending cholangitis in the presence of an obstructing gallstone are emergent indications for biliary decompression with endoscopic retrograde cholangiopancreatography. Rarely, gallstones may erode into adjacent structures, causing fistulas that may manifest as biliary obstruction (Mirrizi’s syndrome); biliary enteric fistula, which may manifest as small bowel obstruction (gallstone ileus); or fistulization with other interfacing organ systems, including the integument, vasculature, thorax, or genitourinary system. Patients with gallstone disease often present with familiar signs and symptoms associated with intra-abdominal disease processes. Hence, it is important to deliberate on good clinical practice and elucidate an appropriate differential diagnosis.

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Authors and Affiliations

  1. Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The Ohio State University Wexner Medical Center, 2nd Floor Doan Office Tower, 395 W. 12th Avenue, Columbus, OH, 43210-1228, USA

    Victorio Pidlaoan M.D. & Somashekar G. Krishna M.D., M.P.H.

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  1. Victorio Pidlaoan M.D.
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  2. Somashekar G. Krishna M.D., M.P.H.
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Correspondence to Somashekar G. Krishna M.D., M.P.H. .

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Editors and Affiliations

  1. The Ohio State University Wexner Medical Center, Chief, Division of General and Gastrointestinal Surgery,, Department of Surgery,, Columbus, Ohio, USA

    Jeffrey W. Hazey

  2. The Ohio State University Wexner Medical Center, Director, Division of Gastroenterology, Hepatology, and Nutrition, Professor of Medicine, Department of Internal Medicine,, Columbus, Ohio, USA

    Darwin L. Conwell

  3. The Ohio State University Wexner Medical Center, Division of Vascular and Interventional Radiology, Department of Radiology, Columbus, Ohio, USA

    Gregory E. Guy

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Pidlaoan, V., Krishna, S.G. (2016). Management of Medical Complications of Gallstone Disease. In: Hazey, J., Conwell, D., Guy, G. (eds) Multidisciplinary Management of Common Bile Duct Stones. Springer, Cham. https://doi.org/10.1007/978-3-319-22765-8_13

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