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Complications of Gallstones: Warning Signs & Emergency Treatment

  • Prof. Dr. Zahid Mahmood
  • August 7, 2026

Complications of Gallstones: Warning Signs & Emergency Treatment

Medically reviewed by Prof. Dr. Zahid Mahmood, MBBS, FCPS — General, Laparoscopic & Laser Surgeon, Lahore.

Most gallstones remain silent, but a stone that blocks the gallbladder or bile ducts can cause serious illness. Complications range from painful gallbladder inflammation to infection, jaundice, pancreatitis and bowel obstruction. Some can become life-threatening without prompt treatment.

This guide explains the main complications, their warning signs, how doctors diagnose them and when emergency medical care is essential.

How do gallstones cause complications?

The gallbladder stores bile made by the liver. Gallstones may remain harmless inside it, but problems occur when a stone becomes impacted in the gallbladder outlet or moves into the main bile duct. The resulting blockage can cause pressure, inflammation, infection or obstruction of the pancreatic duct.

The location and duration of the blockage determine which complication develops.

1. Biliary colic

Biliary colic is often the first warning that gallstones are causing trouble. A stone temporarily blocks the gallbladder outlet, producing severe, steady pain in the upper-right or upper-middle abdomen.

Typical features include:

  • Pain that may spread to the back or right shoulder
  • An attack lasting from several minutes to a few hours
  • Nausea or vomiting
  • Complete or near-complete relief between attacks

Biliary colic is not itself an infection, but repeated attacks indicate symptomatic gallstones. Surgical assessment is advisable because future obstruction may become persistent and cause a complication.

2. Acute cholecystitis

Acute cholecystitis is inflammation of the gallbladder, usually caused by a stone remaining stuck in the cystic duct. Unlike ordinary biliary colic, the pain is persistent and the upper-right abdomen is often very tender.

Symptoms may include:

  • Constant upper-right abdominal pain
  • Fever or chills
  • Nausea, vomiting and loss of appetite
  • Pain when taking a deep breath during abdominal examination

Treatment commonly includes hospital assessment, pain relief, fluids and antibiotics when infection is suspected. Early laparoscopic cholecystectomy is recommended for suitable patients.

3. Gallbladder empyema, gangrene or perforation

Severe or prolonged inflammation can cause the gallbladder to fill with pus, lose its blood supply or rupture. Infection may then form an abscess or spread throughout the abdomen as peritonitis.

Warning signs include worsening pain, high fever, rapid heartbeat, marked tenderness, weakness, confusion or low blood pressure. These are surgical emergencies requiring urgent antibiotics, drainage or an operation.

4. Common bile duct stones and obstructive jaundice

A stone that leaves the gallbladder may lodge in the common bile duct. Bile then backs up into the liver and bloodstream.

Possible symptoms include:

  • Yellow eyes or skin
  • Dark urine
  • Pale or clay-coloured stools
  • Itching
  • Upper abdominal pain, nausea or vomiting

Ultrasound, liver blood tests and MRCP may be used to investigate the blockage. ERCP can remove many bile-duct stones. Gallbladder surgery is usually advised afterwards to reduce the risk of recurrence.

5. Acute cholangitis

Acute cholangitis is infection within an obstructed bile duct. The classic combination is upper abdominal pain, fever and jaundice. Severe infection can cause low blood pressure, confusion, kidney injury and sepsis.

Cholangitis is a medical emergency. Treatment requires hospital resuscitation, intravenous antibiotics and urgent drainage of the obstructed bile duct, commonly by ERCP.

6. Gallstone pancreatitis

A small stone can pass to the lower end of the bile duct and temporarily block the shared opening of the bile and pancreatic ducts. This may trigger acute pancreatitis.

Symptoms often include:

  • Sudden, severe upper abdominal pain
  • Pain spreading through to the back
  • Persistent nausea or vomiting
  • Abdominal tenderness and feeling seriously unwell

Pancreatitis ranges from mild inflammation to severe disease affecting the lungs, kidneys and circulation. It requires urgent hospital care. After recovery, gallbladder removal is usually advised at an appropriate time to prevent another attack.

7. Mirizzi syndrome

In Mirizzi syndrome, a stone impacted in the gallbladder neck or cystic duct compresses or damages the nearby main bile duct. This can cause jaundice, infection and difficult surgical anatomy. Specialist imaging and careful surgical planning may be required.

8. Gallstone ileus

Gallstone ileus is a rare complication in which a large stone erodes from the gallbladder into the intestine and causes bowel obstruction. It occurs more often in older patients.

Symptoms include cramping abdominal pain, vomiting, swelling of the abdomen and inability to pass stool or gas. CT scanning is particularly useful, and surgery is usually needed to relieve the obstruction.

9. Chronic cholecystitis and a shrunken gallbladder

Repeated attacks can lead to chronic inflammation, scarring and a thick-walled or contracted gallbladder. Patients may experience recurrent pain and food-related symptoms. Dense scarring can also make later surgery technically more difficult.

10. Gallbladder cancer

Gallbladder cancer is rare, and most people with gallstones never develop it. Long-standing stones are associated with many gallbladder cancers, but the overall individual risk remains low. Suspicious findings such as a mass, irregular wall thickening or certain enlarging polyps require specialist assessment.

When should gallstone symptoms be treated as an emergency?

Go to an emergency department without delay if you have:

  • Severe or persistent upper abdominal pain
  • Pain with fever or chills
  • Yellow eyes or skin
  • Repeated vomiting or inability to keep fluids down
  • Severe pain spreading to the back
  • A swollen abdomen with inability to pass stool or gas
  • Confusion, faintness, breathing difficulty or extreme weakness

Do not try to manage these symptoms at home with diet changes, antibiotics left from a previous illness or painkillers alone.

How are complications diagnosed?

Assessment may include:

  • Blood tests: full blood count, inflammatory markers, liver tests, kidney function and pancreatic enzymes
  • Ultrasound: the first-line scan for gallbladder stones and signs of acute cholecystitis
  • MRCP: a special MRI scan that shows the bile ducts
  • CT scan: useful for pancreatitis, perforation, abscess, gallstone ileus or uncertain severe abdominal pain
  • ERCP: mainly a treatment to drain an obstructed duct and remove stones

Can complications be prevented?

Silent gallstones usually do not require treatment. Once gallstones cause typical attacks or complications, timely surgical assessment is important. Laparoscopic cholecystectomy removes the gallbladder and is the definitive treatment for most symptomatic gallbladder stones.

A lower-fat meal may reduce symptoms while waiting for treatment if fatty food is a trigger, but diet cannot reliably dissolve existing stones or prevent a moving stone from blocking a duct.

Key message

Gallstones can progress from intermittent pain to acute cholecystitis, jaundice, cholangitis, pancreatitis, perforation or bowel obstruction. Fever, jaundice, persistent severe pain, repeated vomiting or signs of serious illness require urgent medical assessment. Planned treatment of symptomatic stones is safer than waiting for an avoidable emergency.

Consult a gallstone surgeon in Lahore

If you have recurrent gallstone pain, abnormal liver tests or an ultrasound showing stones, Prof. Dr. Zahid Mahmood can review your symptoms and investigations and advise on further testing or laparoscopic surgery.

For an appointment, call 0300 413 0159 or visit professorzahid.com.

This article is for general education and does not replace personal medical assessment. If you have severe pain, fever, jaundice, persistent vomiting or feel seriously unwell, seek emergency medical care.

Medical references

  1. Williams NS, O’Connell PR, McCaskie AW, editors. Bailey & Love’s Short Practice of Surgery. 28th ed. CRC Press; 2023. Chapter 71, “The gallbladder and bile ducts,” pp. 1221–1252.
  2. National Institute for Health and Care Excellence. Gallstone disease: diagnosis and management (CG188).
  3. NICE. Gallstone disease recommendations.
  4. National Institute of Diabetes and Digestive and Kidney Diseases. Gallstones: definition and complications.

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