Mrs. FB, a 62 year old lady suffering from diabetes presented 1 year ago, with a USG report of gall stones. She had no symptoms except a single episode of mild pain in the abdomen.
In view of her being insulin dependent diabetic, she was advised to undergo an operation. She refused surgery as she thought she was asymptomatic.
Currently, she presented with severe pain and fever on a Sunday evening. Blood tests, USG and MRI scan revealed the presence of severe acute infection of the gall bladder and presence of a bile duct stone.
She had to have an emergency admission. Initial treatment with antibiotics was followed by an endoscopy (ERCP) to remove the bile duct stone. She then underwent an emergency Surgery for removal of the gall bladder. At surgery, the gall bladder was gangrenous.
In view of her age and diabetes, she had a rough recovery; and was eventually discharged 10 days later.
Mr. NS, a 57 year old man presented with pain and USG report of gall stones. He too was advised surgery and underwent a laparoscopic (keyhole) surgery. He was discharged the next day after surgery and resumed work in the same week.
The above two case scenarios classically reveal the advantages of an elective surgery versus an emergency unplanned admission.
Gall stones affect 1 in 20 individuals with females being more prone to develop the stones.
• Post Pregnancy
• rapid weight loss
What causes gall stones
Gallstones may develop when there is too much cholesterol in the bile secreted by your liver. Bile usually dissolves or breaks down cholesterol. However, if your liver makes more cholesterol than your bile can dissolve, stones may develop. Hence it is commonly seen in obese people, and people who eat too much fatty food.
Symptoms of gall stones?
• Asymptomatic – Majority of the patient may have no symptoms
• Pain in the upper abdomen
• Acidity type symptoms
• Flatulence, feeling bloated
• Pain after meals
Complications of gall stones
• Infection of the gall bladder ( cholecystitis) causing pain , fever and vomiting
• Gall stone “falling off” into the bile duct and obstructing the system causing jaundice
• Gall stone induced pancreatitis ( Inflammation of the pancreas) one of the nastiest complications of gall stone
Who should be treated
• All patients who are symptomatic
• Patients who had a complication of the gall stone
• Patients with diabetes and suffering from gall stones
How are they diagnosed
A simple sonography of the abdomen would suffice to detect gall stones in suspicious cases.
Sometimes, an MRI of the abdomen is needed.
Key hole surgery ( Laparoscopic) to remove the gall bladder is performed. When the operation is completed laparoscopically, the patient is discharged in 1-2 days and can resume normal duties within a week.