Gallstones Without a Gallbladder: Can You Still Get Them?

Yes, you can still get gallstones without a gallbladder, but they form or lodge in the bile ducts rather than in the gallbladder itself. They are uncommon after surgery, they cause recognizable symptoms, and they can usually be removed without another operation.

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For most people, gallbladder removal ends gallstones for good. That is why it comes as such a shock when, months or years later, a doctor says a stone is causing the pain. It is a common surprise in online communities for people without a gallbladder, often followed by the question of how that is even possible.

The answer lies in what the gallbladder actually was. It stored bile, but it was never the only place bile flows. The bile ducts that carried bile to and from it are still there, and under certain conditions stones can sit in them or form in them.

Can You Still Get Gallstones Without a Gallbladder?

Yes, though strictly speaking they are bile duct stones rather than gallstones in the gallbladder. Doctors call stones in the common bile duct choledocholithiasis, and it can occur in people who have had their gallbladder removed [1]. Bile duct stones are found days to years after cholecystectomy in up to 5 percent of patients [2].

That makes them uncommon, but not rare enough to ignore, especially if you have pain that feels like your old gallbladder attacks. The gallbladder itself cannot grow back. Stones after surgery come from one of three places, described next.

Where Do Gallstones Form If You Have No Gallbladder?

After gallbladder removal, stones are most often found in the common bile duct, the tube that carries bile from the liver to the small intestine. Less often they turn up in a small piece of gallbladder or cystic duct that was left in place [3, 4].

1. Stones left behind at surgery

Some people already have a small stone in the common bile duct when their gallbladder is removed, and it is not always found during the operation. These are called retained stones. Many studies count stones found in the first two years after surgery as retained ones that slipped through, though the cutoff varies [5]. US doctors even have a separate diagnosis code for them [6].

2. New stones that form in the bile duct

Stones can also form from scratch in the bile duct itself, often years after surgery [5, 7]. These are called primary bile duct stones, and they are usually brown pigment stones rather than the cholesterol stones that form in a gallbladder [8]. They are linked to slow bile flow and bacteria in the bile [8], and people who develop them tend to be older and to have a wider bile duct [5].

3. Stones in a remnant gallbladder or cystic duct stump

When the gallbladder is severely inflamed, the structures around it can be hard to identify safely, and removing all of it can put the main bile duct at risk. In that situation a surgeon may remove most of the gallbladder and deliberately leave a small part behind, which is called a subtotal cholecystectomy [9]. Stones can occasionally form again in that remnant, or in a long stump of the cystic duct, and produce pain much like the original attacks [3, 4]. If you are not sure what kind of operation you had, your operative report will say.

How Common Are Gallstones After Gallbladder Removal?

They are uncommon. Up to 5 percent of people have bile duct stones found at some point after cholecystectomy [2], and the risk is higher in some groups than others. After a subtotal cholecystectomy, a pooled analysis found that about 4 percent of patients had gallstone symptoms again and about 2 percent needed a second operation, over a median follow-up of about two years [3].

People who have already had a bile duct stone removed are more likely to have another, and recurrence after a first ERCP has been reported in 4 to 30 percent of patients, about 1 in 7 on average, over follow-up of months to years [10]. That is one reason a doctor who has cleared your duct once will want to hear quickly if similar symptoms return.

What Are the Symptoms of Gallstones After Gallbladder Removal?

The symptoms of a bile duct stone after gallbladder removal often feel like a gallbladder attack. A stone that blocks the duct typically causes [1]:

• Pain in the upper right or upper middle abdomen lasting at least 30 minutes, sometimes spreading to the back near the right shoulder blade
• Nausea and vomiting, and loss of appetite
• Fever
• Yellowing of the skin or the whites of the eyes
• Clay-colored stools, and dark, tea-colored urine [11]

Often there are no symptoms unless the stone blocks the duct [1], and about a third of bile duct stones pass on their own [8].

When is it an emergency?

A stone that blocks the duct can lead to an infection of the bile duct, called cholangitis, or to inflammation of the pancreas, called pancreatitis [1]. Both need hospital care. Pain with fever or chills, or yellowing of the skin or eyes, needs medical attention right away rather than a wait for an appointment [11, 12].

What Causes Pain Like Gallstones but No Gallbladder?

Pain that feels like gallstones after gallbladder removal is not always a stone. Other causes include bile acid diarrhea, bile reflux into the stomach, a stomach ulcer, problems with the sphincter of Oddi, pancreatitis and irritable bowel syndrome [4, 13]. Together they fall under the broad label of post-cholecystectomy syndrome, which we explain in its own article.

Blood tests help tell them apart. A stone that blocks bile usually pushes up bilirubin and liver enzymes [8], so normal results make a blocking stone less likely, although they do not rule one out [14]. That is why a doctor checking upper right abdominal pain after gallbladder removal will usually start with blood work.

Can You Have Gallstones 20 Years After Gallbladder Removal?

Yes. Primary bile duct stones can form many years after surgery, on average about eight years afterward and as long as 28 years in one series [7], and in online communities people describe a first bile duct stone ten years or more after their operation. The risk of bile duct stones also rises with age [8, 14], so they can appear long after you have stopped thinking about your gallbladder. Pain like an old gallbladder attack is worth taking seriously, however long ago the operation was.

How Are Bile Duct Stones Diagnosed?

Diagnosis usually starts with blood tests and an ultrasound, then moves to more detailed imaging if needed [14, 15]:

• Blood tests: liver tests and bilirubin, which rise when bile is blocked, plus a test for pancreatitis
• An abdominal ultrasound, which can show a widened bile duct and sometimes the stone itself
• MRCP, an MRI scan of the bile ducts and the most accurate test that does not involve a scope [1], or endoscopic ultrasound [14]

Doctors weigh the results to judge how likely a stone is. When the evidence is strong, they may go straight to ERCP, which can both confirm the stone and remove it in the same procedure [14].

How Are Gallstones Treated After Gallbladder Removal?

Bile duct stones are usually removed with ERCP rather than surgery [14]. A thin, flexible scope is passed through the mouth and stomach into the small intestine, the opening of the bile duct is widened with a small cut, and the stone is pulled out with a balloon or a small basket. It is usually done under sedation, sometimes general anesthesia, and many people go home a few hours later [16]. ERCP clears the duct in more than three quarters of people the first time and in about 90 percent once repeat procedures are counted [8], and larger or harder stones can be broken up first [14].

The main risk of ERCP is pancreatitis, which follows roughly 7 to 15 in 100 procedures [8, 14]. Stones in a gallbladder remnant or cystic duct stump are a different case: some can be removed endoscopically, but some need a second operation to take out the remnant, called a completion cholecystectomy [4, 3].

How to Avoid Gallstones After Gallbladder Removal

There is no proven way to prevent bile duct stones after gallbladder removal [17]. No diet or supplement has been shown in trials to stop them forming or to dissolve them, and the few medicines studied for this are prescription-only, with limited evidence [17]. Online advice that bile salts, choline or magnesium will clear stones has no evidence behind it. What you can control is how quickly a problem is caught: knowing the symptoms, getting abnormal liver tests followed up, and returning promptly if pain like your old attacks comes back.

If you have had a duct stone removed before, ask your doctor what follow-up they recommend and which symptoms should prompt a call. Recurrence is more likely in some people than others [10], and an early check is simpler than an emergency.

Is It Stones, or Is It Digestion?

Many people who worry about stones after gallbladder removal actually have something more everyday: heaviness, fullness or bloating after rich meals, with normal blood tests and scans. That pattern may reflect how bile now reaches the intestine, as a steady flow from the liver rather than a concentrated dose released with meals [18], and our guide to where bile goes after gallbladder removal explains it.

Spreading fat across your meals is the first thing to try, and our list of best foods to eat without a gallbladder shows how. Some people also take bile support with their largest meal. Dr.Primal's TUDCA is made for life after gallbladder removal and is taken with meals, when your body calls on bile the most, to support healthy bile flow and fat digestion.

In Summary: Gallstones Without a Gallbladder

You can get stones after gallbladder removal, but they appear in the bile ducts, either left behind at surgery or formed there later, and occasionally in a remnant of gallbladder left in place on purpose. They affect up to 5 percent of people, they cause pain much like a gallbladder attack, sometimes with fever or jaundice, and they are usually removed with ERCP.

Know the warning signs and do not wait them out. For the everyday digestive side of life without a gallbladder, our short digestion quiz is a quick way to put your symptoms and habits in order.

This article is for general education and is not a substitute for advice from your doctor. TUDCA is sold as a dietary supplement. These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.