From the Guidelines
Patients with calcified gallstones should undergo surgical removal of the gallbladder (cholecystectomy) if they are symptomatic, as this approach is generally preferred for reducing the risk of gallbladder cancer and alleviating symptoms. Calcified gallstones are hardened deposits in the gallbladder that contain calcium salts, making them visible on regular X-rays unlike most gallstones 1. For asymptomatic calcified gallstones, no treatment is necessary as they often don't cause problems. However, if symptoms occur such as severe upper right abdominal pain, nausea, vomiting, or jaundice, surgical intervention is typically recommended.
Key Considerations
- The choice of treatment for symptomatic gallstones depends on the patient's treatment goals and attitudes, as well as the natural history of the disease 1.
- Laparoscopic cholecystectomy is the standard approach, involving small incisions and a shorter recovery time, but open surgery may be needed in complex cases 1.
- Medications like ursodeoxycholic acid exist to dissolve gallstones, but they're generally ineffective for calcified stones due to their hardened calcium composition.
- Calcification occurs as cholesterol stones age, with calcium binding to the stone surface, and these stones form when bile contains too much cholesterol or bilirubin, or when the gallbladder doesn't empty properly 1.
Risk Factors and Follow-up
- Risk factors for calcified gallstones include obesity, rapid weight loss, certain medications, and genetic predisposition.
- Regular follow-up with a healthcare provider is important if you have known calcified gallstones, especially for patients with large (> 3 cm) stones or those who belong to high-risk populations such as New World Indians 1.
From the Research
Calcified Gallstones
- Calcified gallstones do not respond to treatment with ursodeoxycholic acid 2
- The presence of calcifications is a significant drawback to bile acid dissolution therapy, as it can prevent the effective dissolution of gallstones 3
- Calcified gallstones are often not visible on conventional radiographs, which can lead to treatment failures 3
- Porcelain gallbladder, a condition characterized by gallbladder calcification, is believed to increase the risk of developing gallbladder cancer, although recent reports suggest the risk is lower than previously thought 4
- The management of asymptomatic patients with porcelain gallbladder is debatable, and prophylactic cholecystectomy is not routinely recommended in all patients with this condition 4
Treatment Options
- Ursodeoxycholic acid is effective in dissolving gallstones that are predominantly composed of cholesterol, but it is not effective for calcified or pigment stones 2, 3
- Other treatment options, such as the injection of a cholelitholytic solution or the use of mechanical means to disintegrate gallstones, are also being studied, but these treatments are only effective for gallstones composed mainly of cholesterol without significant calcifications 3
- Laparoscopic cholecystectomy is the treatment of choice for most patients with biliary colic or acute cholecystitis 5
Diagnosis and Risk Factors
- Ultrasonography is the initial imaging choice for detecting gallstones and acute cholecystitis 5
- Risk factors for developing gallstone disease include female sex, older age, certain medications, and having type 2 diabetes mellitus, nonalcoholic fatty liver disease, obesity, rapid weight loss, or hemolytic anemia 5
- The Murphy sign is a specific physical examination finding for acute cholecystitis 5