Acute Biliary Disease

Abstract

Biliary tract diseases requiring emergency or urgent surgical evaluation and treatment are among the most common acute conditions encountered by the general or acute care surgeon. The vast majority of these conditions represent complications of gallstones. Contained within the gallbladder, stones may lead to acute cholecystitis, followed by potential sequelae including gallbladder empyema, gangrene, perforation, liver abscess, or peritonitis. An impacted stone in the gallbladder infundibulum, together with the inflammation thus caused, may partially obstruct the hepatic duct, or even erode into the adjacent duct (Mirizzi syndrome). Similarly, the stone could erode into the adjacent adherent duodenum, ultimately obstructing the intestine. When smaller gallstones escape the gallbladder via the cystic duct into the common duct, the stones, howsoever small, may incite an attack of acute pancreatitis. Or they may obstruct the common duct, causing jaundice; if the bile happens to harbor bacteria, then the result could be acute cholangitis. Cholecystitis can occur without gallstones as a complication of trauma or other acute conditions. Finally, cholecystitis and cholangitis may complicate biliary stent treatment of malignant or benign bile duct stricture.