Elderly patients who develop acute cholangitis may require special care. Pancreatitis can result from choledocholithiasis, because the pancreatic duct, which carries digestive enzymes, joins the common bile duct right after it enters the intestine and so may be blocked by common duct stones. If a gallstone passes through or lodges in the lower common bile duct, pancreatitis can result. It is sometimes difficult to differentiate between pancreatitis and acute cholecystitis, but a correct diagnosis is critical since treatment is very different. A simple urine dipstick test is showing promise in providing early evidence of possible pancreatitis in patients who come to the emergency room with severe abdominal pain.
Imaging techniques are useful in confirming a diagnosis.
Ultrasound is used often. Because most cases are asymptomatic, however, the rates may be underestimated in elderly men. Men who have their gallbladders removed, moreover, are more likely to have severe disease and more operative complications than women. Gallstone disease is relatively rare in children. Those at risk are children with a spinal injury, a history of abdominal surgery, sickle-cell anemia, impaired immune systems, or children who receive nutrition intravenously.