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The gallbladder is a small sac lying on the underside of the liver. The liver produces a liquid called bile (also known as gall), this is stored in the gallbladder. Gallstones are hard pieces of stone-like material. They are made up of different substances including cholesterol, chalk and bile pigment. Up to 20% of people in the West have gallstones and women are affected twice as often as men.
Most people with gallstones remain asymptomatic throughout life, however, stones may lead to the gallbladder becoming inflamed (cholecystitis) this can be very painful. The stones may block the bile duct leading to jaundice or a stone may pass from the gallbladder through the bile duct into the intestine, this can be extremely painful.
Gallstones are often diagnosed by chance and need treatment only if they cause trouble. They will show up on an x-ray and on ultrasound scanning.
There are different methods of treating gallstones, should they require it. Some stones can be dissolved with drugs. The use of ultrasound waves to shatter the stones into tiny fragments is another method, this enables them to pass safely into the faeces. If these methods fail or are not suitable for a particular patient then surgical removal of the gallbladder is indicated.
This can be done through keyhole or open surgery, the former being the method of choice as it is less invasive. This procedure is not without complications, injury to the bile duct and the cystic duct can occur. On the whole these injuries are not regarded as negligent if diagnosed quickly. However, ongoing pain and an increased temperature should alert medical staff to the possibility of a biliary leak which may have been the result of an injury during the procedure. This should be investigated immediately as can lead to biliary peritonitis or sepsis which could be fatal. Most successful litigation occurs in the post operative period where failure to diagnose a complication occurs and further surgery and treatment is necessary.
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