Manifestations of gallstone disease.

In some patients, gallstones are asymptomatic, lying dormant in the gallbladder or wedged in the cystic duct. In others, stones cause specific symptoms of gallbladder disease, such as biliary colic, acute cholecystitis, or cholangitis. Symptoms of flatulent dyspepsia are not markers of gallstone disease, since they occur equally in those with and without gallstones. Complications of gallstone disease include pancreatitis, biliary-enteric fistulas, hydrops, limy bile, porcelain gallsbladder, and carcinoma of the gallbladder. Cholecystectomy is indicated for symptomatic gallstones; for suspected stones in diabetics, who are at high risk should complications of gallstone disease occur; and in a few other limited situations. Prophylactic cholecystectomy for asymptomatic gallstones remains controversial.