Gallstones' Bark Is Bigger Than Its Bite

Medical Author: Jay W. Marks, MD
Medical Editor: Dennis Lee, MD

A patient came to see me for a second opinion about having his gallbladder removed surgically. Although the patient was anxious for the surgery, the referring physician had some doubts. I took a careful history from the patient, examined him, and reviewed the ultrasound study that had found his gallstones.

There was no doubt that the patient had gallstones; the ultrasound was clear. What was not so clear was whether his gallstones were responsible for his most troublesome symptom. Gallstones usually, though not always, cause a characteristic type of abdominal pain referred to as biliary colic. Although the patient had had several episodes of pain that were fairly typical of gallstones, his most frequent and bothersome discomfort was not typical of biliary colic. It was more dyspeptic than biliary. That is, the discomfort was related to meals. (Although it is generally believed that pain from gallstones occurs mostly after meals, studies have shown that this is not so. The pain occurs most commonly in the evening after falling asleep.)

I discussed my thoughts with the patient and concluded by telling him that although I thought his gallstones were causing pain, his most bothersome symptom was not likely to be caused by his gallstones. I had an uneasy feeling that he did not understand what I was telling him. "Doc, I'm so uncomfortable I've got to have this surgery." I responded that there was no more than a 50/50 chance of surgery relieving him of his most troublesome symptom. I still had doubts about his understanding.

Medically Reviewed by a Doctor on 12/1/2014