Gallbladder pain but no stones!
A patient can have typical gallbladder pain and have no detectable gallstones. Such a patient may have acalculous chronic cholecystitis.
An ultrasound is usually the first study done to evaluate a gallbladder. It is economical, fast and painless and is the best study for detecting gallstones.
If a patient with typical gallbladder symptoms has a normal ultrasound they may be further evaluated with a HIDA scan. This scan measures the gallbladders ability to fill up with bile then contract and empty itself of bile. A gallbladder that cannot fill up with bile may have a stone blocking it and this supports the diagnosis of acute cholecystitis. A gallbladder that fills with bile but contracts poorly supports the diagnosis of chronic cholecystitis.
Rare patients have typical gallbladder symptoms and normal ultrasound and normal HIDA scan. These patients need more studies to evaluate organs other than the gallbladder.
Patients that have typical gallbladder symptoms, normal ultrasound, normal HIDA and have completed a thorough evaluation of other organs that could cause their symptoms may find relief by having their gallbladder removed. We usually tell these patients that their chance of having relief from their symptoms with a cholecystectomy is a little better than 50%. Although not perfect, for many patients this is a welcome chance to cure a condition for which they had no other options.