What are the symptoms of passing a gallstone?

Symptoms of Passing Gallstones

When gallstones pass from the gallbladder into the bile duct or duodenum, patients typically experience severe, steady epigastric or right upper quadrant pain that lasts for hours, often accompanied by jaundice, fever, and potentially life-threatening complications including cholangitis, pancreatitis, and biliary obstruction. 1

Classic Pain Presentation

The hallmark symptom of gallstone passage is biliary colic—severe, steady (not cramping) pain that:

• Localizes to the epigastrium and/or right upper quadrant 2
• Begins relatively abruptly, often awakening patients from sleep 2
• Remains steady in intensity rather than waxing and waning 3, 2
• Lasts 4-6 hours or longer, potentially up to a full day 3, 2
• May radiate to the upper back or right shoulder 2
• Is frequently associated with nausea and vomiting 2

Warning Signs of Complications

Complications from passing stones are potentially life-threatening and can occur without warning. 1 When stones migrate into the common bile duct (CBDS), patients may develop:

Obstructive Symptoms

• Jaundice (yellowing of skin/eyes) from partial or complete biliary obstruction 1
• Dark urine and pale stools (implied from biliary obstruction)

Infectious Complications

• Fever indicating possible cholangitis (bile duct infection) 1, 4
• Ascending cholangitis presenting with fever, jaundice, and right upper quadrant pain 1, 5

Pancreatitis

• Severe epigastric pain radiating to the back when stones obstruct the pancreatic duct 1, 4
• Gallstones cause up to 50% of acute pancreatitis cases 1

Important Clinical Context

Not all stone passage is symptomatic. Studies confirm that some patients spontaneously pass ductal stones into the duodenum before or after surgery without experiencing significant symptoms. 1 However, this benign course is unpredictable—the GallRiks study found that 25.3% of patients with untreated common bile duct stones experienced unfavorable outcomes including pancreatitis, cholangitis, or obstruction. 1

Symptoms That Are NOT Related to Stone Passage

Common pitfall: Dyspeptic symptoms including indigestion, belching, bloating, heartburn, and food intolerance are frequently attributed to gallstones but are probably unrelated to the stones themselves and often persist after surgery. 6, 2 These atypical symptoms are less likely to resolve following cholecystectomy. 6

When to Seek Immediate Care

Patients should seek urgent evaluation if they experience:

• Pain lasting longer than 6 hours 3
• Fever in combination with abdominal pain (suggests acute cholecystitis or cholangitis) 1, 4
• Jaundice (indicates bile duct obstruction) 1, 4
• Severe pain with abdominal tenderness and leukocytosis (suggests acute cholecystitis) 3

These presentations warrant immediate ultrasound evaluation and potential intervention, as patients with severe symptoms who fail to improve within 48 hours despite intensive treatment may require urgent ERCP (endoscopic retrograde cholangiopancreatography). 6