Q: Our father is 65 years old and in relatively good shape. He used to be a heavy smoker but gave up the habit 10 years ago and is a casual drinker. He exercises regularly but has been limited due to a weak knee.
He also has constant problems with heartburn and is continuously taking heartburn treatments, such as Rennies.
He has bad leg cramps and arthritis, for which he uses a multitude of natural herbal remedies but no prescription medication, and he is not on any chronic medication.
About six years ago he was diagnosed with gallstones. He was advised to have his gall bladder removed but did not. A month ago he became seriously sick (vomiting, nausea, fever, pain and stomach cramps). He was hospitalised and put on painkillers and an antibiotic drip. The diagnosis was gallstones.
They would have operated that same day but first decided to confirm the diagnosis. The operation was therefore delayed, our father responded well to the painkillers and antibiotics and it was decided to discharge him the next day.
The tests confirmed gallstones, but as his symptoms were much better, an operation was scheduled for September.
He has recovered from the infection caused by the gallstones and is reluctant to pursue the surgical route. He believes that if he went six years without requiring treatment since the initial diagnosis, he can go another six or more without any intervention. Is this wise?
Is surgery the only option or are there any “alternative” non-surgical treatments? We would appreciate your advice.
Shaun and Tony Miller Cape Town
A: Thank you for such a concise and well-presented case. I often get queries regarding this issue. Most physicians recall with great fondness the orthodox gallstone cholecystitis patient profile: Fat, Forty, Fertile, Female. This is often overinterpreted, as we see many male patients in older age groups with cholecystitis. The area where the associated colicky pain is dominant is referred to as the right hypochondrium – over the liver under the rib margin, extending to the stomach area. Nausea is truly intense and a flushed sensation accompanies this wave of illness.
Diagnosing gall bladder inflammation
Inflammation secondary to the presence of gallstones in the gall bladder (which lies tucked in just under the liver) is identified on special imaging tests like the abdominal sonar as well as a more detailed abdominal CT scan. They show the presence of gallstones as wall thickening of the bladder.
Blood tests are also useful in detecting the elevation of certain liver enzymes due to swelling and pressure effects on the draining bile ducts or tubes.
Gallstone pancreatitis is a dangerous complication if the condition is not dealt with timeously.
Conservative management during the acute inflammatory stage includes intravenous analgesia, anti-emetics and antibiotics.
The problem is that the gallstones move into the bile ducts and cause obstruction – leading to recurrent inflammation.
Patients often feel better once the nausea and pain are treated. However, if you do not remove the stones and gall bladder, you run the risk of repeated cholecytitis. A necrotic (rotting) gall bladder can cause dire complications, including severe sepsis and death.
The procedure is called a cholecystectomy and the gall bladder can be removed by endoscopic surgery in most cases. The operation was previously a lot more intrusive, with larger incisions and associated complications: