Can Gallstones Be Defecated Out?
Yes, gallstones can spontaneously pass from the bile ducts into the duodenum and be eliminated through the gastrointestinal tract, though this occurs unpredictably and is not a reliable treatment strategy. 1
Natural History of Spontaneous Stone Passage
Studies confirm that a number of patients will spontaneously pass ductal stones into their duodenum before or after laparoscopic cholecystectomy, and small unsuspected stones can have a benign natural history. 1 This phenomenon is well-documented in the medical literature, particularly for stones that have migrated from the gallbladder through the cystic duct into the common bile duct (secondary common bile duct stones). 1, 2
Clinical Context and Limitations
When Spontaneous Passage Occurs
- Most commonly affects secondary common bile duct stones that originate in the gallbladder and migrate through the cystic duct. 1, 2
- The presence of multiple small gallstones (<5 mm) in the gallbladder creates a 4-fold risk for migration into the common bile duct. 1
- Once in the bile duct, stones may pass through the papilla of Vater into the duodenum and subsequently through the intestinal tract. 1
Critical Safety Concerns
Even small stones (<4 mm) can cause serious complications including pancreatitis, cholangitis, and biliary obstruction, with 15.9% of conservatively managed patients experiencing adverse outcomes. 2 This makes expectant management hoping for spontaneous passage a risky strategy.
Why This Is Not a Treatment Strategy
Unpredictable and Dangerous
- The natural history of common bile duct stones is less well understood than gallbladder stones, and complications can occur without warning. 1
- Complications are potentially life-threatening and include pain, partial or complete biliary obstruction leading to obstructive jaundice, cholangitis, hepatic abscesses, pancreatitis, and secondary biliary cirrhosis. 1
Current Treatment Recommendations
It is recommended that patients diagnosed with common bile duct stones are offered stone extraction if possible, with evidence of benefit greatest for symptomatic patients. 1 This reflects the consensus that active intervention is safer than waiting for spontaneous passage.
Clinical Pitfall to Avoid
Do not adopt a "wait and see" approach hoping stones will pass naturally. While spontaneous passage does occur, the unpredictable timing and high risk of serious complications (cholangitis, pancreatitis, biliary obstruction) make active treatment the standard of care. 1, 2 The fact that stones can pass spontaneously is a clinical observation, not a treatment recommendation.