Gall Stone Movement and Nonsurgical Treatment

QUESTION: After many years without any sign of their presence, my gall stones
suddenly sent a painful signal of their presence. My doctor thought that one
had gotten stuck in a little tube inside, but before any tests could be
performed, I got better. I was told if it happened again, the stone could be
removed without an operation. I want to know what caused the stone to move
now, and how they get it out without surgery?
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ANSWER: It's not unusual for gall stones (biliary calculi) to remain silent
for long periods of time, and it is possible that you may not hear from them
again if you are both careful and lucky. About 20 million Americans share
your situation, and more than 500,000 gall bladders are removed each year (by
an operation known as a cholecystectomy). Gall stones form when the bile
contains a heavy concentration of cholesterol, but other less well understood
factors also play important roles. The gall bladder stores the bile between
meals, and then contracts when food to be digested reaches the area of the
intestines called the duodenum. The bile is pushed from the gall bladder to
the intestine through two small tubes, the cystic duct and the common bile
duct. Trouble starts when a stone that has been quietly residing in the gall
bladder goes for a ride along with the bile, and becomes stuck in the narrow
passage formed by the ducts. You are made aware of the fact by severe
abdominal pain, nausea, vomiting and fever. Frequently, a heavy, rich meal
has preceded this event, and probably was a part of the cause. Physicians may
locate the exact position of the stone using ultrasound waves or x-rays.
Although surgery to remove both stones and gall bladder is the most common
treatment, a newer procedure is available to doctors today when a stone
becomes lodged in the tract. A long tube called an endoscope may be passed
down the esophagus, through the stomach to the intestines. An instrument
which can be inserted inside the tube, may be used to crush or extract the
lodged stone. The procedure is a lot less traumatic than the surgical
operation. Your physician may choose to prescribe medications now, before the
next attack, which can dissolve the stones present in the gall bladder, and
prevent any future attacks.