How do gallstones present, and how often are they asymptomatic?

About 80% of gallstones are asymptomatic ('silent stones'), often found incidentally on imaging. Symptomatic disease ranges from biliary colic and acute/chronic cholecystitis to common bile duct obstruction, cholangitis, pancreatitis, mucocele, and Mirizzi's syndrome.

Clinical relevance. Knowing most stones are silent shapes the decision not to treat asymptomatic gallstones.

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Presentation of gallstones

Most gallstones never cause symptoms, but a wide spectrum of disease can result when they do.

Asymptomatic

• About 80% are asymptomatic ('silent stones'), often found incidentally on imaging.

Symptomatic spectrum

• Biliary colic.
• Acute cholecystitis and chronic cholecystitis.
• Common bile duct obstruction (choledocholithiasis) and acute cholangitis.
• Acute pancreatitis.
• Mucocele or empyema of the gallbladder; Mirizzi's syndrome; gallstone ileus.

Useful framework

• Manifestations can be grouped by site: in the gallbladder, in the bile ducts, or in the gut.