Complications of cholelithiasis include acute cholecystitis, common bile duct obstruction, and acute pancreatitis. Biliary colic may cause right upper quadrant or diffuse abdominal pain. This abdominal pain may also be due to peptic ulcer disease in patients with SS disease and should be considered in the history and, if indicated, evaluated by examination of the upper gastrointestinal tract. Ultrasound also provides information about the liver and pancreas and saves the patient multiple x-ray exposures associated with contrast cholecystography. In most patients, management does not differ from that used in the general population.
Most physicians defer surgery until symptoms occur.
However, some physicians recommend cholecystectomy once stones are identified because of frequent difficulty in diagnosing the cause of abdominal pain in children with sickle cell disease. In adult patients, vague right upper quadrant discomfort after meals can be relieved by antispasmodics. Some patients remain symptom free for many years by avoiding dietary excesses and restricting their intake of fried and fatty food. When gallstone symptoms are chronic or recurrent, elective cholecystectomy is indicated. Right upper quadrant pain is not relieved by surgery in all patients.