The two common complications of chronic cholecystitis and cholelithiasis are acute cholecystitis and choledocholithiasis. These complications tend to develop late in the course of gall-bladder disease, occurring with much greater frequency in patients who have harbored gallstones for many years. Recognizing this tendency, Glenn1 suggested routine exploration of the common duct in all patients over 60 years of age with gall-bladder disease.
The fact that acute cholecystitis, as well as common-duct stones, occurs more frequently in older patients suffering from long-standing gall-bladder disease suggests that these conditions might frequently be associated. Actually their association has rarely been stressed. It is usually assumed that the incidence of choledocholithiasis in acute cholecystitis is low.
Among the authors reporting a low incidence is Cole,2 who stated that only 4 to 5% of patients with acute cholecystitis have associated common-duct stones. Glenn3 found choledocholithiasis 40 times (6.5%) in 613 cholecystectomies for