Mr. Nhan was diagnosed with small gallstones two years ago. As they were asymptomatic, he did not seek treatment. For the past two months, he experienced intermittent abdominal pain and occasional vomiting, which he attributed to gastritis. When the pain worsened, he went to Tam Anh General Hospital in Ho Chi Minh City. A CT scan revealed acute cholecystitis, an enlarged gallbladder, impaired hepatic parenchymal perfusion, suspected gallbladder necrosis, and peripancreatic fat stranding. Localized fluid collections were observed, with the gallbladder adhering to the hepatic flexure of the colon and the duodenum. Several gallstones were present in the cystic duct.

Doctor Pham Cong Khanh, Head of the Hepatobiliary and Pancreatic Department at the Center for Endoscopy and Minimally Invasive Digestive Surgery, said the gallstones in Mr. Nhan's gallbladder were quite small. However, due to the delayed hospital visit, the stones caused complications of adhesion and gallbladder necrosis. Gallstones had also migrated into the common bile duct, leading to acute pancreatitis. The doctor recommended a "two-in-one" procedure: an endoscopic retrograde cholangiopancreatography (ERCP) to remove the common bile duct stones and a laparoscopic cholecystectomy to prevent further complications.

Doctor Khanh (left) performing laparoscopic cholecystectomy on Mr. Nhan. Photo: Tam Anh General Hospital

Doctor Khanh (left) performing laparoscopic cholecystectomy on Mr. Nhan. Photo: Tam Anh General Hospital

During the ERCP, the doctor identified two small gallstones (5-6 mm) in the common bile duct, along with 5 mm bilateral dilation of the intrahepatic bile ducts. The doctor performed a sphincterotomy and used a balloon to remove all the stones, followed by a laparoscopic cholecystectomy. The doctor noted the surgery was challenging due to the necrotizing cholecystitis and the gallbladder's adhesion to vital organs such as the hepatic flexure of the colon and the duodenum. There was a high risk of bleeding during dissection because of adhesion and significant edema in the hepatobiliary triangle.

Post-surgery, Mr. Nhan's abdominal pain subsided, he was able to walk and eat, and he was discharged after three days. A week later, during a follow-up appointment, his health was stable.

The doctor explaining pancreatitis to Mr. Nhan during his follow-up appointment. Photo: Tam Anh General Hospital

The doctor explaining pancreatitis to Mr. Nhan during his follow-up appointment. Photo: Tam Anh General Hospital

Gallstones form due to an imbalance between cholesterol and bile salts in the bile. Gallstones with an average diameter of 6-10 mm can cause noticeable symptoms. Doctors usually recommend surgery for stones with a diameter of 12-14 mm. In some cases, smaller stones can block the cystic duct or fall into the common bile duct, causing pancreatitis, which requires prompt surgical intervention to prevent dangerous complications.

To prevent gallstones and their potential complications, Doctor Khanh recommends maintaining a balanced and healthy diet, undergoing regular deworming, and having annual health checkups. Individuals experiencing unusual symptoms should seek care at reputable medical facilities equipped with adequate diagnostic and treatment capabilities to ensure timely and effective intervention and prevent complications.

Quyen Phan