The Mercedes Benz sign is usually detected in patients with cholelithiasis, which is a severe disease of swelling of the gallbladder. Source: iStock

The presence of Mercedes Benz sign in radiological findings (computed tomography or CT of the abdomen) may indicate gallstones in the belly. Mercedes Benz sign is a collection of nitrogen gas among the stones. This gas fills spaces created by the shrinking of cholesterol crystals in the stone. They usually radiate like points of stars that appear like the Mercedes Benz sign in radiological findings. The Mercedes Benz sign is usually detected in patients with cholelithiasis, which is a severe disease that is characterized by the swelling over the gallbladder as well as the formation of stones (gallstones) in the gallbladder and bile ducts.

What are the signs and symptoms of cholelithiasis?

The common signs and symptoms of cholelithiasis may include:

  • Patients complain of pain just below the ribs and over the right side of the belly. The pain aggravates after overfeeding or intake of foods, such as fatty meats, fatty, and fried food, chocolate and liquor, highly carbonated drinks.
  • Nausea and vomiting
  • Bad taste in the mouth
  • The pain may often radiate to the back or right shoulder
  • Belching
  • Possible jaundice
  • Fever
  • Dark urine
  • White feces (these symptoms are the result of blocking the flow of bile from the gall stones)

 The majority of patients are at risk of recurrence of symptoms or onset of complications:

  • Acute cholecystitis: Swelling of the gallbladder.
  • Chronic cholecystitis/porcelain gallbladder: May lead to cancer of the gallbladder.
  • Acute cholangitis: Swelling of ducts in liver and intestine.
  • Jaundice: Condition in which the skin, whites of the eyes, and mucous membranes turn yellow because of a high level of bilirubin.
  • Gallbladder cancer: Gallstones are the main etiological factor of carcinoma of the gallbladder.

What are the different types of gallstones?

The different types of stones in cholelithiasis are:

  • Cholesterol stones
    • They occur in 10% of all types of stones.
    • Macroscopically they have a spherical or oval shape. They are more often single, and their size reaches 5 cm in diameter. Their color is white or pale yellow.
  • Bilirubin stones
    • They occur in approximately 15% of patients with cholelithiasis.
    • Macroscopically they contain some calcium, which gives them their characteristic hardness. They are numerous and faceted with sharp edges.
    • Their color is dark green to greenish-red.
    • They reach a size of 10 mm in diameter.
  • Mixed
    • They are detected in 75% of cases of cholelithiasis.
    • Macroscopically they may be single, but they more frequently occur as multiple stones.
    • Their size rarely exceeds 1 cm in diameter.
    • Their color is greenish, whitish-yellow to black, depending on which of the constituent components dominate.
    • Their surface is fine-grained. They have a firm texture.
    • In section, a shell is visible with brown-red color with caramel core radial structure of cholesterol.
    • By section of other stones, a concentrically lamellar structure can be seen. They are composed of bilirubin, cholesterol, and calcium.


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What are the treatment options for cholelithiasis?

The treatment options of cholelithiasis may include:

  • Asymptomatic cholelithiasis: Unless the individual shows symptoms like pain or develops complications, there is no need for treatment. "Porcelain gallbladder" is an exception, which needs surgery because of the increased risk of developing cancer.
  • Frontline cholelithiasis: After the onset of symptoms, they tend to recur. In these patients, there is a risk for the occurrence of complications. Consequently, most patients with symptoms of gallstones should be treated.
  • Gallstones often occur in patients with other diseases. Therefore, in patients with gallstones and atypical pain or dyspepsia diagnosis should be clarified.
  • Laparoscopic cholecystectomy (bloodless removal of the gallbladder) provides a safe and effective treatment for symptomatic gallstones. Indeed, it is the treatment of choice in these patients. This method avoids larger incisions on the abdominal wall, so there are no complaints regarding the abdominal wound and no concerns of scar formation. The mobilization of the patient is faster, the risk of unwanted events is limited, and the hospital stay is shorter.

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Sureka B, Bansal K. Mercedes-Benz Sign. J Clin Diagn Res. Published online October 1, 2016. doi: 10.7860/JCDR/2016/15669.8680