Gallstone after gallbladder surgery puzzles reader

DEAR DR. ROACH: I was diagnosed with Gilbert syndrome after I had a blockage of my common bile duct and became jaundiced. This was three months after I had my gallbladder removed (via an open surgery). How was it possible for me to develop a stone after the surgery? Was the Gilbert syndrome caused by the blockage? — J.E.

ANSWER: Let’s start with gallstones, the most likely cause of the blockage. Surgical treatment of gallstones is the most effective treatment, but it is possible, about 10 percent of the time, to develop a stone after surgery. This happens sometimes when a stone is retained in the bile duct and is not noticed during surgery. It is more common in laparoscopic surgery than in open surgery. It also is possible for new stones to form if any remnant of the gallbladder is left. These can be treated with endoscopic removal or with medication to dissolve them.

Gilbert syndrome is caused by a deficiency of an enzyme used to conjugate bilirubin, a component of bile and a breakdown product of red blood cells. It leads to elevated levels of bilirubin in the blood (specifically, a type of bilirubin called unconjugated: the blood tests can distinguish between conjugated and unconjugated). Under times of stress — such as exertion or dehydration — people with Gilbert syndrome can become jaundiced — they exhibit a yellow coloring, which is easiest to see in the sclerae (whites of the eyes) or in the mouth. However, Gilbert syndrome usually does not cause any problems, and does not need treatment.

People with Gilbert syndrome (which runs in families and is very common) are at higher risk of developing gallstones. So, the blockage didn’t cause the Gilbert syndrome: You’ve had it your whole life. The Gilbert syndrome may have put you at risk for the gallstones.

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