Most cholecystectomy however is performed electively for treatment of recurrent attacks of gallstone pain. Although other treatments such as lithotripsy or dissolution may be also effective for gallstone disease, the vast majority of patients who require treatment should undergo cholecystectomy. The most frequently seen bacterial pathogen in cholangitis includes E. coli, Klebsiella, and other enteric organisms. Unlike in the case of gallstone disease, patients typically present with painless jaundice. Patients with malignant obstruction usually have bilirubin levels 2-3 time higher than patients with stone disease.
Diagnosis usually requires cholangiography and treatment consists of relief of obstruction.
Chronic pancreatitis Just as a cancer at the head of the pancreas can cause obstructive jaundice, chronic pancreatitis and resulting inflammation may also lead to obstruction of the intrapancreatic portion of the bile duct. Benign biliary strictures usually occur as consequence of prior surgical injury and my present also with painless jaundice. It may be difficult, even impossible to distinguish benign from malignant stricture in some patients.