Doctors were today warned to look out for a serious and potentially fatal infection in people with gallstones amid concerns that many patients were suffering because the condition was not promptly diagnosed.

Up to one in 11 patients admitted to hospital with gallstone disease also suffer from acute cholangitis, inflammation of the bile ducts that can quickly lead to septicaemia, shock and death if untreated, according to the medical journal Drug and Therapeutics Bulletin (DTB).

The main symptoms of the infection are a high fever, abdominal pain and sometimes jaundice, but the DTB said that doctors were failing to spot the condition because less than a third of patients displayed all three of these symptoms. Most patients have a fever, but often no jaundice and pain can be very mild, the journal reported.

Cholangitis is usually caused when the bile ducts are obstructed by gallstones, preventing infected material from escaping into the bowel. This leads to pus gathering in the gall bladder, which can lead to liver abscess or eventual cirrhosis of the liver. The condition is potentially fatal and requires emergency hospital admission and prompt treatment.

The DTB said that doctors should be particularly alert to acute cholangitis in older patients with unexplained fever and abnormal liver function test results, regardless of whether or not they have pain and jaundice.

Dr Ike Iheanacho, editor of the DTB, said: "Acute cholangitis is a medical emergency and needs to be spotted and dealt with quickly. Doctors need to consider it as a possibility even in patients who do not have all the classical features of the disease."