💛 Men's Health

Gallstones: Causes, Symptoms & Treatment

Understanding gallstone disease in Nigerian patients

Gallstones are hardened deposits of bile that form in the gallbladder. They range from tiny sand-like particles to stones larger than a golf ball. Most gallstones in Nigeria are cholesterol stones (from bile oversaturated with cholesterol) or pigment stones (from haemolytic conditions like sickle cell disease). Many people have gallstones without symptoms — but when stones block the bile duct or inflame the gallbladder, they cause severe pain and potentially life-threatening complications.

Signs and Symptoms

✓ Biliary colic: severe episodic pain in the upper right abdomen, lasting 30 minutes to several hours

✓ Pain may radiate to the right shoulder blade or back

✓ Nausea and vomiting during pain episodes

✓ Pain triggered by fatty or heavy meals

✓ Jaundice (yellow eyes and skin) — stone blocking the bile duct

✓ Fever with jaundice and abdominal pain — acute cholangitis (emergency)

Risk Factors

Female sex, obesity, pregnancy, over 40 years (the classic 4 Fs: Fat, Forty, Female, Fertile)
Rapid weight loss or prolonged fasting
Sickle cell disease: chronic haemolysis leads to pigment stone formation
Diabetes and insulin resistance
Family history
Low-fibre, high-fat diet

When to Seek Help

EmergencyFever with jaundice and right upper abdominal pain (Charcot's triad) = cholangitis; or severe epigastric pain radiating to the back = pancreatitis — both are medical emergencies

UrgentPersistent jaundice, recurrent vomiting, inability to eat

ElectiveConfirmed gallstones causing recurrent biliary colic — schedule cholecystectomy before a complication occurs

Tests & Diagnosis

🧪 Abdominal ultrasound

Best first test — shows gallstones with 95% accuracy; also assesses bile duct diameter

🧪 Liver function tests

Raised bilirubin and alkaline phosphatase suggest a stone in the bile duct

🧪 FBC and CRP/ESR

Raised white cell count and inflammatory markers if gallbladder is inflamed (cholecystitis)

🧪 MRCP (MRI cholangiography)

Non-invasive imaging of bile ducts — shows stones in the common bile duct before surgery

🧪 ERCP

Endoscopic procedure to remove bile duct stones — combines diagnosis and treatment

Treatment Options

Laparoscopic cholecystectomy

Definitive treatment — keyhole removal of gallbladder; standard of care; 1–2 day hospital stay; most patients return to work within 2 weeks

Open cholecystectomy

Used for complicated cases or where laparoscopy fails; longer recovery (5–7 days hospital)

ERCP for bile duct stones

Endoscope removes stones blocking the common bile duct before or instead of surgery

Pain management during acute attack

IV buscopan, diclofenac suppository, or IV morphine for severe biliary colic; keep nil by mouth during acute attack

Diet during waiting period

Low-fat diet reduces gallbladder stimulation and attacks while awaiting surgery — avoid fatty meats, fried foods, and heavy meals

Frequently Asked Questions

Do gallstones always need surgery?

Gallstones that have never caused symptoms ('silent gallstones') in most adults can be observed. However, once symptomatic, surgery is recommended because attacks recur and complications can be life-threatening.

Can gallstones dissolve without surgery?

Ursodeoxycholic acid can dissolve small cholesterol stones over 12–24 months, but stones often recur. Surgery is more reliable for symptomatic stones.

Is life normal after gallbladder removal?

Yes — most people live normally without a gallbladder. The liver still produces bile which flows directly to the intestine. Some people experience loose stools for a few weeks while adjusting.

Are gallstones linked to sickle cell disease?

Yes — the chronic red blood cell breakdown in sickle cell disease produces excess bilirubin, leading to pigment gallstone formation. All sickle cell patients should have gallbladder ultrasound screening.

How much does gallstone surgery cost in Nigeria?

Laparoscopic cholecystectomy at private hospitals: ₦250,000–₦600,000. Government hospitals: lower with NHIS subsidy. Confirm NHIS coverage before referral.