Duct Gallstones

What causes stones to form in the gallbladder and bile ducts?

The formation of stones is determined by many factors. Calculi, i.e. stones, can form due to various types of metabolic disorders and inflammatory processes of different genesis. Stones can form in different organs, most commonly in the gallbladder. The function of this organ has a certain importance - the gallbladder is a reservoir, where the bile not only collects but also concentrates. This is a prerequisite for the formation of sludge and then calculus.

Who can suffer from stones in the bile duct?

Depending on the cause of the stones (bearing in mind the role of pregnancy as a cause of bile passage disorder), it should be noted that women are more prone to develop stones. The same can be said for overweight people of both sexes. At the same time, it should be noted that gallstones and duct stones can be detected even in patients who do not have any of the above conditions.

What are the risks of gallstones and duct stones to humans?

These risks are acute destructive inflammation of the gallbladder, jaundice and inflammation of the ducts due to the passage of stones through the duct, and the development of pancreatitis. The fact that the prolonged presence of stones in the gallbladder is a prerequisite for the development of gallbladder cancer is also very important.

At what stage does a gallstone manifest itself?

It takes some time for a stone to form, but once formed it may not manifest itself for years until it becomes inflamed or the duct is blocked. After this, pain of varying intensity and frequency appears, mostly in the right subcostal area. It is believed that even in the absence of symptoms, the presence of stones in the organ over many years contributes to the development of cancer. Typically, if there is a tumor in the gallbladder, the patient also has stones. Early detection of gallstones is therefore very important.

How are gallstones detected if a patient is asymptomatic?

Modern X-ray examinations can detect stones in different organs. They are usually easy to see in the gallbladder. It is therefore important that a person has prophylactic examinations routinely. This enables timely detection not only of stones but also of many other simple or complicated diseases.

What are the first symptoms indicating the passage of a stone in the bile duct?

The first and universal symptom is severe abdominal pain. If the process is accompanied by inflammation, the patient also has a fever. The situation worsens in a short period of time. In cases of acute cholecystitis caused by stones, the patient is often operated on. If the common bile duct is obstructed by a stone, jaundice occurs, among other symptoms, because the bile can no longer pass into the duodenum. In this case, interventional radiology is included in the treatment process.

What methods are used to dissolve stones "stuck" in the duct at New Hospitals?

At New Hospitals, treatment is determined on a multidisciplinary basis. If necessary, a patient with acute pain is referred to the department of interventional radiology. One of the high-tech procedures of interventional radiology is the evacuation of bile duct stones in the duodenum. In the case of a large stone (or stones), laser fragmentation (disintegration) of the stones is carried out before the evacuation.

In the first stage, a tube (catheter) is inserted through the liver into the duct to evacuate the bile and decompress the bile ducts and, in case of infection, to evacuate the purulent contents. The discharge of bile is necessary to relieve the patient from symptoms such as jaundice, inflammation and fever.

A few days after the liver function has been restored, the stone stuck in the duct is treated. Without any incision, a special operating tube (introducer) is inserted into the duct through an existing catheter fistula (created channel) and a high-pressure balloon is passed through it under the stone, expanded into the papilla, after which the stuck stone is transported back into the intestine using the balloon.

Lithotripsy (stone disintegration) can be added to this procedure, which is performed for stones larger than 2 cm, as the conventional removal of stones of this size is technically difficult and traumatic for the duct. In this procedure a special endoscope is inserted before the balloon is inserted through the same introducer and a laser lithotripter is passed through its operating channel to the stone under direct visual control, which fragments the stone and ensures its unhindered passage into the intestine by means of the balloon and liquid lavage.

How often are stones disintegrated by laser and what does the process (lithotripsy) look like?

As we have already mentioned, it becomes necessary when the stone is large; the procedure itself is technically complex, time-consuming and requires expensive equipment. The patient is not calm at this time, as the intervention is carried out under general anesthesia.

What is the rehabilitation process after the procedure?

The laser lithotripsy procedure does not actually requires a rehabilitation process. Due to the need for general anesthesia the patient is usually discharged the next day, although it is sometimes possible to send them home after a few hours of observation. If the procedure is performed against a background of a severe general condition or any other comorbidities, the patient will continue to be treated as an inpatient in the appropriate department. After the procedure, no special dietary or lifestyle restrictions are imposed on the patient; on the contrary, if previously they had to live with certain restrictions, they are now freed from them.