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Q. Is surgery needed for acute cholecystitis with cholelithiasis?

Answered by
Dr. Arvind Guru
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on May 26, 2017 and last reviewed on: Oct 09, 2018

Hello doctor,

I am having right abdominal pain since last five days. I am not getting relief after taking medicines also. My ultrasound says that the gallbladder is distended with a 6.8 mm calculus at the gallbladder neck. The gallbladder wall is 5.6 mm and appears thickened. The gallbladder is filled with sludge. According to the report, I have acute cholecystitis with cholelithiasis. Do I need a surgery? Or can it be cured by medicines?

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Hi,

Welcome to icliniq.com.

It is very tempting to treat gallbladder stones with dissolving drugs, but there are some very important limitations, which are as follows.

  1. Those drugs require up to two years of treatment.
  2. They do not prevent the formation of new ones.
  3. They cannot be used on all types of stones.
  4. Leaving behind the gallbladder will still lead to problems.
  • If it is stuck in the neck, as in your case, there are two possible ways:
  1. Do an operation right now, today itself. It is advisable within a week of onset of pain. It is more cost effective.
  2. Give you medications and then operate after six weeks. This is preferred by most surgeons as it makes surgery easier and safer. Here the current problem is cured with medications and to prevent further recurrence or a stone getting stuck, surgery is done. The downside is that, during this treatment, what if the current problem is not fixed by medication, this probability is around 20 %.
  • I have a suspicion that you have lost a considerable amount of weight recently. In this case, dissolution therapy can work, but only in some cases. But, it is not a very good option as 6 mm stone can trickle down and cause problems.
  • The chance of not ever having recurrence attack is less than 30 %. In around 50 % cases, you will have a second attack within a year. It is also important to consider why you developed a gallbladder stone at this young age. You could be suffering from some blood disorder. Talk to your doctor about it. If that is the case, dissolution treatment will not work for you anyways.
  • So, I think surgery is the best option for you. Discuss the above with your doctor.

Hope that helps. Follow-up if you need more information or leave a feedback if you like.

For more information consult a surgical gastroenterologist online --> https://www.icliniq.com/ask-a-doctor-online/surgical-gastroenterologist


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