How to treat gallstones or how to treat gallstones without stones? Can surgery be avoided? We talked about this condition Mrs. Bianca Istratie, from the DigestMed clinic, exclusively for DOCTOR THE DAY.
The gallbladder represents an interprandial ball storage body, which is required for optimal digestion. When inside the gallbladder, calculations form the specific pain known as biliary colic (pain located in the right upper abdomen with irradiation in the right shoulder associated with nausea and vomiting).
A challenge commonly encountered in practice is biliary colic in the absence of stones (allithiasis) which designates pain with localization in the right upper abdomen with irradiation in the right shoulder, accentuated by a high fat mass that strongly contracts the cholecyst and is frequently associated with nausea and vomiting on the field of a gallbladder without stones, apparently without modifications at first sight at the ultrasound evaluation. Clinical examination and laboratory tests (liver and pancreatic samples) are within normal parameters.
Studies show that in 15% of the cholecyst operations there were no calculations in the cholecyst, the intervention being performed in the context of a persistent and annoying alithiasis biliary colic or of the alitiazic cholecystitis (often produced by affecting the circulation of the cholecyst), a totally different entity from the first. .
It seems that this condition generally occurs in young women mimicking lithic biliary colic (produced by the presence of calculi in the cholecyst).
More than half of the patients with cholecystectomized alithiasis biliary colic have very small microscopic calculations. An analysis of the biliary content is necessary in this regard.
In another important part of these patients, the existence of cholesterol (deposition of cholesterol in the wall of the gallbladder with thickening and stiffening), which can alter the effective contracting of the cholecyst has been proven on histological examination.
Another category of patients with the same symptoms had significant inflammation in the wall of the gallbladder after its removal, a feature of chronic alithiasis cholecystitis.
In patients with normal histopathological examination of the cholecyst, it was observed that the pain can be generated by the lack of coordination between the contraction of the cholecyst and the relaxation of the sphincter Oddi (an important circular muscle that controls the release of the ball in the intestine).
The latter type represents patients with functional biliary colic, the cause sustained all the more as the patient associates with other gastrointestinal functional disorders explained by visceral hypersensitivity.
When we operate the cholecyst on a patient with biliary colic?
Cholecystectomy remains a difficult decision for these patients. Recurrent, persistent colicative episodes with long evolution support the therapeutic decision.
For patients with microcrystals in the bile contents, almost half of those with biliary colic alithiasis, the therapeutic solution is cholecystectomy.
At the same time, cholecystectomy is a therapeutic solution for patients with blunt dysmotility (impairment of cholecyst contraction), in which the histopathological examination revealed chronic cholecystitis in 90% of patients.