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Gallstones

What are gallstones?

Gallstones are small stone-like objects that form when the liquid in the gallbladder hardens. This liquid is called bile. It helps the body digest fats.

The liver makes bile, and the gallbladder stores it until the body needs it. Then the gallbladder contracts and squeezes bile out into the intestine. A series of tubes connects the liver, gallbladder and intestine. The tubes leaving the liver are called the hepatic ducts. The tube leaving the gallbladder is called the cystic duct. These combine to form the common bile duct, which goes to the intestine.

Bile contains water but also several solids: cholesterol, fats, salts and proteins. It also contains bilirubin, a yellowish pigment. Usually gallstones are made mostly of cholesterol. Some are made of bilirubin.

If gallstones get lodged in a duct, they can block the flow of bile. This can cause the duct or the gallbladder to swell. Ongoing blockage can damage the liver, the gallbladder or the pancreas, which also connects to the common bile duct. Blockage can lead to infection, too. Organ damage and infection can both be serious problems.

Who gets gallstones?

Most people who get gallstones are adults. Gallstones are not as common in kids, but some children do get them. Children are at increased risk for gallstones if they have certain inherited blood problems, such as sickle cell disease or spherocytosis. Obesity, family history of gallstones and some medicines can increase risk, too. Most children with gallstones have no specific underlying cause for them.

What are the symptoms?

Sometimes gallstones form but cause no symptoms. When gallstones do cause symptoms, the symptoms tend to come on suddenly. The most common symptom is pain in the upper belly (abdomen) that gets worse and lasts for at least 30 minutes — maybe for as long as a few hours. Your child may feel the pain more on the right side. For most children prior to adolescence, it is difficult for them to pinpoint their pain. Their pain may be vague. Some older children or young adults may complain of back pain or pain between the shoulder blades. Blockage from a gallstone can also cause nausea, vomiting, fever and jaundice, a yellowish tint to the skin and eyes.

How do you diagnose gallstones?

If the doctor suspects your child has gallstones, your child will need an ultrasound exam. An ultrasound machine emits sounds waves that bounce off the gallbladder and other organs to form a picture on a video monitor. The doctor can look for gallstones in this picture.

Ultrasound is the most common way to diagnose gallstones. Sometimes doctors use other imaging techniques to look for gallstones or blocked ducts or to check how well the gallbladder is working.

Your child may need blood tests, too. Blood tests may show signs of infection or other problems related to gallstones.

What is your experience with gallstones at Children's?

We have treated many children with gallstones at Children's, and we have one of the largest reports in the medical literature on the treatment of this disease in children. Our surgeons have extensive experience in performing laparoscopic cholecystectomy (pronounced koh-leh-sist-EKT-uh-mee), the most common way of removing the gallbladder, and in dealing with the possible complications of gallstone disease, such as problems with the liver or pancreas.

When you come to Children's, you have a team of people to care for your child before, during and after surgery. Along with your child's surgeon, you are connected with nurses, dietitians, child life specialists and others. We work together to meet all of your child's health needs and help your family through this experience.

Since 1907, Children's has been treating children only. Our team members are trained in their fields and also in meeting the unique needs of children. For example, the doctors who give your child anesthesia are board certified in pediatric anesthesiology. This means they have extra years of training in how to take care of kids. Our child life specialists know how to help children understand their illnesses and treatments in ways that make sense for their age. Our expertise in pediatrics truly makes a difference for our patients and families.

How do you treat gallstones?

If gallstones cause symptoms, your child will need surgery to remove the gallbladder. This surgery is called cholecystectomy. If the gallstones don't cause symptoms, treatment may not be needed.

It's okay not to have a gallbladder. Bile simply flows from the liver directly into the intestine. Your child should be able to eat and do everything else normally after having their gallbladder removed. The most common symptom after removing the gallbladder is loose stool, especially after eating a fatty meal. But most children do not have this problem.

Surgery

In most cases, surgeons can remove the gallbladder using laparoscopic surgery. This means they make several small cuts, or incisions, in the abdomen instead of one large incision (open surgery). They insert a thin, lighted tube with a camera and their surgical instruments through these small incisions. Then they snip the gallbladder free and remove it through one of the openings. The advantage of laparoscopic surgery is that surgeons don't have to cut through the stomach muscles, and children recover faster. This is also called minimally invasive surgery. On rare occasions children need to have open surgery instead of laparoscopic surgery if the child has had other abdominal operations in the past. Your surgeon will be able to discuss with you the possibility of needing this.

During surgery the surgeon may perform a cholangiogram, which is a dye study of the bile ducts. This is to be sure no gallstones have fallen out of the gallbladder and into the main bile duct. This study is not always needed. If it is performed and does show gallstones in the main bile duct, the surgeon will try to remove them. This can be very difficult to do laparoscopically in a child because the bile ducts are usually very small.

Your child may need an ERCP (endoscopic retrograde cholangiopancreatography) to get the stones out. This is performed by passing a lighted scope through the child's mouth, past the stomach and into the upper small intestine (duodenum), where the doctor can see the bile duct entering the intestine. Small instruments can be passed through this scope to remove the gallstones. This often avoids the need to do a larger operation on the child. Usually this is done on a different day than the gallbladder removal surgery.

At the time of surgery, your child will have general anesthesia. This means we will give your child medicine to make them sleep without pain during the surgery. The surgery takes about one to two hours, and your child will be in the recovery room for another hour.

After surgery

After laparoscopic surgery, you can expect your child to stay in the hospital for one to two days. Once your child is home, you may need to limit their activity for several days.

After open surgery, you can expect your child to stay in the hospital for two to seven days. You may need to limit your child's activity for several weeks while they recover.

In either case, we will give your child pain medicine to make them comfortable. You'll need to keep the incisions clean and dry until they heal. The surgery team will teach you how to do this and tell you about any activity limits.

About two to three weeks after surgery, your child will need to see the surgeon for a follow-up visit. The surgeon will make sure the incision is healing and your child is recovering well.

Resources

Read more about what to expect when your child visits a clinic at Children's, has surgery here or needs to stay in the hospital. You can get practical details about topics like what to do and bring the day of surgery and who will be on your child's care team. You can also take a virtual tour of our surgery rooms and other parts of the hospital.

To learn more about this condition, you may want to visit our resource list.