Pain similar to that caused by gallstones sometimes occurs in people who have no gallstones or who have gallstones too small to be detected by ultrasonography. It is called acalculous biliary pain.
Acalculous biliary pain is most common among young women.
This disorder may develop when bile (produced by the gallbladder) does not pass through the ducts into the small intestine as it usually does. Passage of bile may be slowed or blocked because
Some people with acalculous biliary pain eventually develop other unexplained (functional) disorders of the digestive tract.
Doctors suspect this disorder if people have biliary pain but ultrasonography shows no stones.
The best way to confirm the diagnosis is unclear. Usually, cholescintigraphy, a type of radionuclide imaging (see Radionuclide (Radioisotope) Scanning), is done after people are given a drug that causes the gallbladder to contract. If the gallbladder does not fully contract, removing the gallbladder may cause symptoms to resolve.
Surgical removal of the gallbladder (cholecystectomy) is usually done using a flexible viewing tube called a laparoscope. After small incisions are made in the abdomen, the laparoscope and surgical instruments inserted through the incisions. Doctors then use instruments to remove the gallbladder.
Cholecystectomy may also cause symptoms to resolve if they were caused by gallstones that are too small to be detected by ultrasonography.
Last full review/revision February 2014 by Ali A. Siddiqui, MD