Gallstones are frequent in the Western world, with up to 10% of the general population affected. Gallstone prevalence is higher in the elderly and in women. Acute cholangitis and pancreatitis are the most serious complications of gallstones, with considerable morbidity and mortality. We discuss here clinical features, laboratory and radiological examinations, and treatment for gallstone cholangitis and pancreatitis. The diagnostic approach for acute 'idiopathic' pancreatitis is dealt with in some detail. Also, the role in pancreatitis of enteral nutrition, antibiotic prophylaxis, and the place of endoscopic retrograde cholangiography with papillotomy for biliary decompression is discussed in detail.