Gallstones are hard particles that develop in the gallbladder that can be as small as a grain of sand or as large as a golf ball. Your gallbladder is most likely to give you trouble if something blocks the flow of bile through the bile ducts. That is usually a gallstone, which is formed when substances in bile harden. Gallstone attacks often happen after you eat. Signs of a gallstone attack may include nausea, vomiting or pain in the abdomen, back or just under the right arm.
Gallstones are most common among older adults, women, overweight people, Native Americans and Mexican Americans.
Gallstones are often found during imaging tests for other health conditions. If you do not have symptoms, you usually do not need treatment. The most common treatment is removal of the gallbladder. Fortunately, you can live without a gallbladder. Bile has other ways to reach your small intestine.
The presence of at least one gallstone in the common bile duct is referred to as choledocholithiasis. If the stones travel into the common bile duct, the tube connecting the liver to the intestine, they can become stuck and block the flow of bile.
Your physician will examine you for abdominal tenderness and blood tests may reveal an abnormally high liver function.
Your doctor may then perform an abdominal ultrasound, which will detect gallstones in either the gallbladder or common bile duct. Ultrasound will also reveal any thickening of the wall of the gallbladder, which would indicate an infection.
The treatment for gallstones that obstruct the common bile duct is endoscopic retrograde cholangiopancreatography (ERCP) or, in more serious and recurring cases, laparoscopic cholecystectomy (removal of the gallbladder).
Endoscopic Retrograde Cholangiopancreatography (ERCP)
ERCP combines the use of a flexible, lighted scope (endoscope) with X-ray pictures to examine the tubes that drain the liver, gallbladder and pancreas. ERCP can treat certain problems identified during the procedure. If an abnormal growth is seen, an instrument can be inserted through the endoscope to obtain a sample of the tissue for further testing/biopsy.
If a gallstone is present in the common bile duct, the doctor can sometimes remove the stone with instruments via the endoscope. A camera is passed through the mouth into the intestine to the opening of the common bile duct. Dye is injected into the duct and any blockage or stone is identified. If a stone is present, balloons or cages can be used to remove the stone from the duct, thereby avoiding open surgery.
Laparoscopic cholecystectomy involves removal of the gallbladder using multiple small incisions and a camera rather than a single large incision. It is often performed for symptomatic cholelithiasis or cholecystitis, typically caused by gallstones. Patients usually have no residual symptoms once they recover from cholecystectomy. Occasionally, they may have some residual nausea or diarrhea, which usually resolves within a month or so.
Laparoscopic cholecystectomy is safe and effective. However, in the presence of infection, adhesions, or variations in anatomy, this method may become dangerous and your surgeon may therefore make the traditional incision to safely complete the operation. This is done to prevent serious complications.
Why seek treatment at The Ohio State University Wexner Medical Center?
Ohio State is recognized by U.S.News & World Report as one of the nation's highest performing hospitals in gastroenterology and GI surgery. With extensive experience managing simple and complex cases, our surgery and GI teams work together to create a multidisciplinary approach, using endoscopic and operative methods for management and diagnosis. Patients have access to a full range of treatments, including minimally invasive surgical techniques such as laparoscopy, robotics and single incision.
In 2014, Ohio State's Wexner Medical Center received the "2014 Gastrointestinal Care Excellence Award" from Healthgrades, the leading online resource for information about physicians and hospitals. The award recognizes hospitals for superior outcomes in bowel obstruction treatment, colorectal surgeries, gallbladder removal, esophageal/stomach surgeries, treatment of gastrointestinal bleeds, treatment for pancreatitis, and small intestine surgeries. Patients who have these treatments or surgeries at these nationally recognized hospitals have a lower risk of dying or experiencing a complication during their hospital stay.