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Gastroenterology  (Expert Forum)
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Is it possible to have gallstones after having the gallbladder removed?
Answered by
Kevin Pho, MD - Internal Medicine
Kevin, M.D. Boston - MA
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MedHelp Member's Question

Is it possible to have gallstones after having the gallbladder removed?

by martima1, Jun 20, 2003 12:00AM
I'm a 38 yr old female with GERD. I had my gallbladder & appendix removed. GB surgery was in Aug of 1999. In July of 2002 I started having abdominal pain in my upper right quad along with aggravated symptoms of GERD.Upper GI showed sliding hiatal hernia and wave during swallowing (otherwise ok) and CT scan showed normal results but common bile duct showed 5mm dilatation. My Symptoms subsided until May 2003. In May, I had an Ultrasound performed which showed normal results but showed my common bile duct has now dilated to 9mm. My Gastro Dr is going to perform an ERCP. Per my Op report a cholangiography was performed (when GB was removed) that didnt show any stones in the common bile duct, or rather showed freeflowing fliud going through my common bile duct.  Is it possible for the body to form gallstones AFTER the gallbladder has been removed and tests showed no gall stones were in the bile duct at time of surgery?

My concern is that I may have a malignant tumor or something terminal!I feel like I have "something" in my abdomen - especially when I move around, bend etc.Like a dull ache all the time. I also have pain in my back (left side though) right under my left shoulder blade. Both pains usually subside after I lay down. If I'm active or sitting upright, I get the pain and during the day it gets worse. Would this be related to my condition? My Dr said my blood tests all came back within normal ranges but is very non-committal about whether I have gall stones in my common bile duct although he says 90% of the time tha is what it is from. However, he wont commit and says he has to wait for the ERCP results. So in the meantime I'm freaking out!



So my questions are:



Is it possible to form gallstones after gallbladder surgery?

How large can a common bile duct stone get?

Is it possible that a gallstone could have gone from 5mm to 9 mm in the span of 8 months?

Is the pain & symptoms I describe related to common bile duct stones?

What are the statistics for ERCP -  what % findings are gallstones vs tumors for my age group?

What is the likelyhood that I could have a tumor? ( I did drink, smoke for a few years and am overweight - 169 lbs 5-2'- other than GERD - healthy female)

I guess I'm looking for some kind of reassurance before I undergo the ERCP.

What would the symptoms be if I had a tumor?  



Doctor's Answer

by Kevin Pho, MD, Jun 20, 2003 12:00AM
Hello - thanks for asking your question.



Surgeon has kindly addressed most of your issues, so I won't repeat them here.  



Although I cannot comment on how likely you have a tumor, I can cite statistics - I assume you are interested in cholangiocarcinma (i.e. bile duct tumors).  



Cholangiocarcinoma accounts for approximately 3 percent of all gastrointestinal malignancies, with a prevalence in autopsy studies of 0.01 to 0.46 percent. About 6800 cases of biliary tract cancer are diagnosed annually in the United States, two-thirds of which are gallbladder cancer. The balance, approximately 2000 to 3000 cases per year, are cholangiocarcinoma.



As a general rule, the incidence of biliary tract cancers increases with age; the typical patient with cholangiocarcinoma is between 50 and 70 years of age.



In the United States and Europe, the main risk factors are PSC (primary sclerosing cholangitis) and choledochal cysts.



ERCP would be the most reasonable test to determine whether there is a stone or tumor present.  If this is done with manometry, Sphincter of Oddi dysfunction can be diagnosed as well.  



Followup with your personal physician is essential.



This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.



Thanks,

Kevin, M.D.



Bibliography:

Kim et al.  Epidemiology; pathogenesis; and classification of cholangiocarcinoma.  UptoDate, 2003.



Member Comments (8)

by surgeon, Jun 20, 2003 12:00AM
a tumor would likely not cause intermittant pain, and would probably be causing jaundice. 5 mm is normal for common bile duct size. 9 mm is at the large end of the range, but can be seen as a "normal" finding in many who've had their gallbladder out. ERCP is very likely to find a stone if there is one. It's not likely you have a stone. They can be any size, even in the duct. It's possible to have them after surgery, usually because they were there and not found at the time of surgery. It's rare, but not absolutely impossible, to form stones de novo in the bile duct after gallbladder removal. If there's no stone, you could have the infamous sphincter of oddi dysfunction, oft referred-to in this forum. When you have the ERCP, it's possible the sphincter (the opening of the bile duct into the intestine) would be enlarged (cut) to take care of the problem.

by ConcernedGB, Jun 21, 2003 12:00AM
To: Martima1
Hello-

I could tell from your post that you are really worried.  I'm no doctor, but the odds of you having the cancer that Dr. Kevin mentioned are probably quite low.  Although he did not directly say that you're odds are low, cholangiocarcinoma is quite rare, only 2,000-3,000 diagnosed per year in the United States and most of those folks are 50 to 70 years-old.  The odds are in your favor.  Looks like you're new on this board.  "Surgeon" is a really experienced physician who has done thousands of surgeries in the gall bladder region and often comments to posts on here.  Please note that he said that the diameter of your bile duct is not tremendously large, maybe even in the end range of normal for someone who has had their gallbladder out.   Furthermore, if there was a blockage by a tumor, you'd be yellow (jaundiced by now).  I know what it feels like to panic about health issues.  It will just make your feel worse.  Relax, have the tests done, and realize the odds are in your favor.  Please let everyone know how it comes out!

by martima1, Jun 21, 2003 12:00AM
Thank you concerned GB. You have certainly helped me this weekend. I want to say thanks to all of you for your help and expertise. I did have some questions regarding the ERCP:



I understand that I will be sedated, but that I will still be conscious? (twilight they say) I guess I'm afraid I will gag on the tube.. I guess if its anything like an endoscopy, i will be ok.. I will let you know how it goes.. Wish me luck and thanks for the extra reassurance. It means alot to me.



martima1

by surgeon, Jun 21, 2003 12:00AM
It IS endoscopy; the same kind of scope passed in the same way. It just means adding a look at and injection of dye into the bile duct opening.

by Moya