32 years old female presented to us with complaints bloating, distension, and heaviness mostly after junk, fatty foods for which she was routinely taking over the counter medication on her own for the last 3 to 4 months, assuming it due to gas in layman's language. During this period, she also had a few episodes of recurrent pain in the right upper abdomen, which used to radiate to the back and shoulder on the right side. Most of the time, the pain was associated with nausea and vomiting. She contacted her family physician, and an ultrasound was advised, which revealed that her gall bladder was full of stones.
She consulted Dr Manish K Gupta, Vice Chairperson and Senior Consultant, Laparoscopic & General Surgeon at Sir Ganga Ram Hospital, Delhi. After thorough workup, she was taken up for key hole surgery of removal of gall bladder (Laparoscopic Cholecystectomy) along with stones. 10mm and 5mm holes were made in her abdomen, and the gall bladder was taken out. It was surprising to find out on opening the gall bladder that it was full of multiple large and small stones numbering almost more than 1500
The incidence of gall stone disease is on the rise due to changing lifestyle, sometimes long gaps between two meals and long fasting leads to precipitation of bile leading to stones. Similarly, females are more prone to develop stones due to their hormones, especially during pregnancy, which again relaxes gall bladder and avoids it's complete emptying.
The patient was discharged on the very next day of surgery and was able to eat a normal diet and move around independently.
Though it seems that small stones might not cause any problem to a common man but due to their small size, these small stones sometimes slips down in to the common bile duct (CBD) and can lead to jaundice and pancreatitis. These are severe complications and need further intervention like endoscopic removal of CBD stone (ERCP) prior to laparoscopic surgery to clear the duct. Similarly, large stones, if left untreated in gall bladder for a very long time, can predispose to cancer of gall bladder due to chronic irritation. These are severe complications, and one shouldn't wait for such complications to happen.
Some patients have silent stones and are not symptomatic, but it doesn't mean that they can't cause any complications. Laparoscopic surgery is now a gold standard for gall bladder stone treatment as there is no medical management.
