Comment:

Gallstones are extremely common in Western society. By far the commonest type of gallstones are the so-called mixed stones. These stones are multiple, 1-3 cm in diameter. They may be round, or have faceted surfaces. They are composed largely of cholesterol. Risk factors include increased cholesterol in bile, which is associated with increasing age; female gender; obesity; racial and genetic factors; high fat diet; diseases associated with elevated circulating levels of cholesterol, including diabetes mellitus and some forms of hyperlipidaemia.

Complications of gallstones include:

1) Recurrent pain in the right upper quadrant of the abdomen (as in this case), known as "biliary colic". This is caused by passage of stones along the gallbladder outlet (cystic duct) and the common bile duct.

2) Obstruction of:

a) The cystic duct or neck of the gallbladder to cause acute and chronic cholecystitis (as in this case);

b) The common bile duct, causing obstructive jaundice;

c) The Ampulla of Vater (where the common bile duct and pancreatic duct empty into the duodenum), resulting in pancreatitis.

3) Secondary bacterial infection, leading to:

a) Empyema of the gallbladder (as in this case);

b) Gangrene of the gallbladder wall;

c) Perforation (rupture) leading to peritonitis;

d) Inflammation of the bile ducts caused by obstruction of the common bile duct - ascending cholangitis;

e) Septicaemia (as in this case)

4) Carcinoma of gallbladder. This is a rare cancer, with most cases occurring in patients with gallstones.