How can a patient have a cholelithiasis (gallstone) without a gallbladder?

From the Guidelines

You cannot have a gallbladder stone without a gallbladder, but you can develop bile duct stones after gallbladder removal (cholecystectomy). These stones, called post-cholecystectomy syndrome stones, can form in the common bile duct either as new stones or as previously undetected stones that migrated from the gallbladder before surgery. The mainstay of therapy for choledocholithiasis, which is the presence of stones in the bile ducts, is endoscopic biliary sphincterotomy and stone extraction during ERCP, with a reported success rate of 90% 1.

Key Points to Consider

• Risk factors for developing bile duct stones after gallbladder removal include bile stasis, infection, and changes in bile composition after gallbladder removal.
• Symptoms of bile duct stones may include abdominal pain, jaundice, fever, and digestive issues.
• Treatment typically involves endoscopic retrograde cholangiopancreatography (ERCP) to remove the stones, sometimes with sphincterotomy to widen the bile duct opening, as supported by the study in the Journal of the American College of Radiology 1.
• In some cases, particularly those involving large (>10-15 mm) impacted stones, additional therapy in the form of lithotripsy or stone fragmentation may be required, with a reported success rate of 79% 1.
• Prevention strategies include maintaining a healthy weight, eating regular meals, limiting fat intake, and staying hydrated. If you experience symptoms after gallbladder removal, seek medical attention promptly as complications like pancreatitis or cholangitis can develop if bile duct stones are left untreated.

From the Research

Gallbladder Stone Without a Gallbladder

It is possible to have a gallbladder stone without a gallbladder, as stones can form in the bile ducts even after the gallbladder has been removed.

• The bile ducts can contain stones, known as bile-duct stones or common bile duct stones, which can cause symptoms such as biliary colic, pancreatitis, jaundice, or cholangitis 2.
• Primary bile-duct stones can form in the absence of gallbladder stones and are more common in East Asian countries than in Western countries 3.
• The formation of primary and secondary bile-duct stones is thought to have different pathogeneses, and the epidemiology, pathogenesis, and classification of biliary stones differ according to stone location 3.

Diagnosis of Bile Duct Stones

Diagnosing bile duct stones can be done using various imaging techniques, including:

• Transabdominal ultrasound
• Computed tomography
• Endoscopic ultrasound
• Magnetic resonance cholangiography
• Endoscopic retrograde cholangiography (ERC) 2, 4
• Contrast-enhanced ultrasound examination can also be used to assess the gallbladder and bile ducts, especially when conventional ultrasound is inconclusive 5.

Treatment of Bile Duct Stones

Treatment of bile duct stones usually involves removal of the stones, which can be done endoscopically or surgically.

• Approximately 90% of bile duct stones can be removed using endoscopic retrograde cholangiography (ERC) and sphincterotomy 2.
• Other treatment options include mechanical lithotripsy, pneumatic dilatation of the sphincter of Oddi, shockwave lithotripsy, and laser lithotripsy 2.