Can Bile Duct Stones Be Eliminated Naturally?

Symptoms of biliary stones can be quite evident in some patients, but intrahepatic biliary stones may not present any notable symptoms and are often incidentally discovered during routine medical check-ups. In cases where symptoms are not severe, some patients may not actively seek treatment and hope that the stones will pass naturally from their bodies, although the possibility of this happening is unclear. So, can biliary stones pass out naturally?

For a minority of patients with smaller stones within the biliary ducts, there is a possibility that the stones may pass into the intestinal cavity through the hepatic duct and common bile duct. In such cases, patients may experience transient abdominal pain, and some may develop symptoms related to cholangitis. For such scenarios, it is recommended that patients promptly receive intravenous infusions of broad-spectrum antibiotics. Additionally, timely abdominal ultrasonography and magnetic resonance imaging are necessary, along with blood tests for routine blood parameters and liver and kidney function, if required. For the majority of patients, the spontaneous passage of stones from the biliary ducts is less likely. Instead, endoscopic retrograde cholangiopancreatography (ERCP) for stone extraction or laparoscopic biliary exploration with the use of cholangioscopy and stone retrieval baskets are more commonly considered options. In necessary cases, a T-tube may be placed for active supportive drainage.

Non-surgical Treatment: This approach is suitable for young patients experiencing their first episode, those who experience rapid symptom relief with non-surgical measures, and patients who have been ill for more than three days and do not have urgent surgical indications. Common treatment measures include bed rest, dietary restrictions or a low-fat diet, intravenous fluids, correction of electrolyte imbalances and acid-base disorders, anti-infective therapy, analgesia, gallbladder stimulation, and supportive measures. In cases of shock, anti-shock therapy should be intensified, including oxygen administration, maintenance of blood volume, and timely use of vasopressors.

Surgical Treatment:

(1) Surgical Management of Extrahepatic Biliary Stones:

• Choledocholithotomy and T-tube drainage: This is the preferred method, which can be performed laparoscopically or through open surgery. It is suitable for patients with isolated common bile duct stones, unobstructed upper and lower biliary ducts, and no narrowing or other pathologies.
• Bilioenteric anastomosis: Also known as internal biliary drainage, this is indicated in cases where obstruction caused by inflammation in the distal common bile duct cannot be resolved and in patients with biliary dilation. It may also be considered when part of the bile duct has been resected due to pathology and cannot be re-anastomosed.
• Oddi sphincteroplasty: This is suitable for patients with mild dilation of the common bile duct and concomitant stenosis or impacted stones in the lower part of the common bile duct.

(2) Treatment of Intrahepatic Biliary Stones:

• Choledocholithotomy: This procedure is commonly used in emergency and severe cases to temporarily clear the biliary tract, control biliary infections, and improve liver function to save lives.
• Partial hepatectomy: This involves removing the diseased segment of the liver to maximize the removal of stones, stenosis, and dilated bile ducts. It is the most commonly used method for treating intrahepatic biliary stones.
• Repair and reconstruction of narrow hepatic duct: Procedures such as bile duct stenosis plasty, Roux-en-Y anastomosis of the jejunum, or repair with tissue patches may be used in cases where stenosis has been removed from the intrahepatic lesion and upstream hepatic duct.