Asymptomatic cholelithiasis concomitant with other abdominal surgical conditions: risk of additional cholecystectomy and fate of untreated gall stones

ABSTRACT

Forty-seven cases of asymptomatic cholelithiasis have been encountered during celiotomy for various abdominal conditions. Concomitant cholecystectomy was performed in 34 cases [72.3%], with operative cholangiography in 20 cases of them, while the common bile duct was explored with removal of stones in 4 cases. No mortality cases were recorded while, 3 patients [8.8%] developed wound sepsis and another 4 [11.8%] developed chest problems. No cases of subphrenic abscess, retained CED stones, biliary fistula or burst abdomen were encountered. Cholecystectomy was not performed in 13 cases [27.7%], because of failure to appreciate the presence of gall stones, unstable condition of the patients, short life expectancy or fear of spread of infection. One patient was lost to follow-up, while 10 patients [83.3%] developed various biliary problems within one year after the primary operation. Four of them developed acute cholecystitis with one in the early postoperative period. In another 5 cases, cholelithiasis became symptomatic with development of obstructive jaundice in one of them. The tenth patient developed acute haemorrhagic pancreatitis, however he died despite of early surgical intervention. We conclude that, if asymptomatic gall stones are encountered during celiotomy for other conditions, cholecystectomy should be carried out unless specific contraindications exist, as it adds minimal morbidity to the primary procedure. Left untreated, cholelithiasis becomes symptomatic in most patients and may cause serious biliary problems and this can lead to subsequent operation which may require a more extensive procedure producing a greater morbidity