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TITLE OF CASE

Standalone successful Ayurvedic management of cholelithiasis- A case report

Dr Rajnikanth 

ABSTRACT

A 9-year-old female patient presented with right upper abdominal pain which lasted for few hours for 3-4 months. She was given analgesics to relieve pain. The pain was still persisting, and USG done confirmed the Biomedical diagnosis as cholelithiasis. When the pain reoccurred, the patient opted for Ayurveda and consulted Dr Rajnikanth. The ayurvedic diagnosis was Pittashaya ashmari. The line of treatment followed was pitta hara and shotha hara. The target of the medicines was lekhana karma, to help eliminate the ashmari in the pittashaya. Three days after starting the Ayurvedic treatment, the pain reduced, and the tenderness was absent in the epigastric region. After 1 month of treatment, the patient had complete relief from the symptoms. Repeat USG done after treatment shows no significant abnormality.

KEYWORDS

Gallbladder, cholelithiasis, ashmari, pittashaya, case report, standalone

INTRODUCTION

Gallstones are hardened deposits of digestive fluid that can form in your gallbladder. Your gallbladder is a small, pear-shaped organ on the right side of your abdomen, just beneath your liver. The gallbladder holds a digestive fluid called bile that's released into your small intestine. Gallstones are hardened deposits of bile that can form in the gallbladder. Bile is a digestive fluid produced in the liver and stored in gallbladder. When we eat, the gallbladder contracts and empties bile into the small intestine (duodenum). Gallstones range in size from as small as a grain of sand to as large as a golf ball. Some people develop just one gallstone, while others develop many gallstones at the same time.

Symptoms- Gallstones may cause no signs or symptoms. If a gallstone lodges in a duct and causes a blockage, the resulting signs and symptoms may include: 

Sudden and rapidly intensifying pain in the upper right portion of your abdomen 

Sudden and rapidly intensifying pain in the centre of your abdomen, just below your breastbone 

Back pain between your shoulder blades 

Pain in your right shoulder 

Nausea or vomiting 

Gallstone pain may last several minutes to a few hours.

Causes: An exact cause is not being defined. But, some factors identified are when the bile contains too much cholesterol or bilirubin, or when the bladder does not empty the contents correctly.

Types of gallstones: There are different type of gall stones depending on the depending on the appearance and the composition. 

Cholesterol gallstones. The most common type of gallstone, called a cholesterol gallstone, often appears yellow in colour. These gallstones are composed mainly of undissolved cholesterol, but may contain other components. 

Pigment gallstones. These dark brown or black stones form when your bile contains too much bilirubin.

Complications: Complications may include 

Inflammation of the gallbladder.

Blockage of the common bile duct.

Blockage of the pancreatic duct.

Gallbladder cancer. 

Diagnostic criteria- Medical history taking and clinical evaluation are the basic diagnostic criteria, followed. Apart from this the general technique followed are Abdominal and Endoscopic Ultrasound, Imaging like HIDA, CT, MRCP, ERCP, are used two understand the intensity of the problem. Blood tests are done to identify or rule out any infections.

Prognosis & Treatment available: Most people with gallstones that don't cause symptoms will never need treatment. Your doctor will determine if treatment for gallstones is indicated based on your symptoms and the results of diagnostic testing. The doctor may recommend that you be alert for symptoms of gallstone complications, such as intensifying pain in your upper right abdomen. If gallstone signs and symptoms occur in the future, you can have treatment. 

Treatment options for gallstones include: 

Surgery to remove the gallbladder (cholecystectomy). 

Medications to dissolve gallstones. 

Laparoscopic cholecystectomy

PATIENT INFORMATION

In this case report, a 9-year-old female patient presented with right upper abdominal pain which lasted for few hours since 3-4 months. She was given analgesics to relieve pain. The pain was still persisting, and USG done confirmed the Biomedical diagnosis as cholelithiasis. When the pain reoccurred, the patient opted for Ayurveda and consulted Dr Rajnikanth.

No relevant family/surgical/psychosocial/genetic history.

Addictions- Nil

CLINICAL FINDINGS

Per abdominal examination done- Mild tenderness- in right epigastric area 

TIMELINE

Image 1. Timeline of events added below

DIAGNOSTIC ASSESSMENT

Modern Diagnostic parameter; The condition was pre diagnosed as Cholelithiasis based on the presenting complaints and the USG report. 

Image 2. USG done at Baseline dated 21.3.2023

Ayurvedic Assessment was done based on the presenting complaints, and the clinical evaluation. 

Differential Diagnosis- 

Acute Pancreatitis

Appendicitis

Bile Duct Strictures
Peptic Ulcer Disease
Gallbladder Cancer
Irritable bowel syndrome
Based on the USG report and clinical evaluation, the the diagnosis was confirmed as Cholelithiasis. 

Prognosis & Treatment available: Management of gallstones depends on the symptoms and the age of the patient. In children, symptomatic gallstones need cholecystectomy. This patient had tried analgesics for 3-4 months prior to confirmation of diagnosis, but pain always recurred. Three days after the initiation of Ayurvedic treatment, the pain reduced and the tenderness was absent in the epigastric region. After 1 month of treatment, the patient attained complete relief from the symptoms.

THERAPEUTIC INTERVENTION

Please refer the tab ‘Treatment’ in the Portal. 

FOLLOW-UP AND OUTCOMES

Both objective and subjective parameters were assessed to analyse the outcome of the ayurvedic treatment. 

Subjective parameters: Three days after the initiation of Ayurvedic treatment, the pain reduced and the tenderness was absent in the epigastric region. After 1 month of treatment, the patient attained complete relief from the symptoms.

Objective parameters:  Repeat USG was done at endpoint, detected no cholelithiasis. 

Clinician-based assessment; Symptoms during the treatment were assessed to analyse the outcome of the treatment. 

Patient-assessed; Not relevant

Endpoint Evaluation:

Image 3. USG at endpoint dated 29.4.2023

Intervention adherence and tolerability – The patient adhered to the prescribed treatments and tolerated the treatments well. 

Method of assessment- By monitoring the patient.

Adverse and unanticipated events; None reported

DISCUSSION: 

Management of gallstones depends on the symptoms and the age of the patient. In children, symptomatic gallstones need cholecystectomy. This patient had tried analgesics for 3-4 months prior to confirmation of diagnosis, but pain always recurred. The ayurvedic diagnosis was Pittashaya Ashmari and the medicines and therapies chosen were pitta hara and shotha hara. Lekhana dravya were included to help eliminating the ashmari. 

PATIENT’S PERSPECTIVE

Not available. 

LEARNING POINTS/TAKE HOME MESSAGES 

This patient being a child of 9 years, her parents did not want surgery as recommended by the allopathic doctor and so ayurveda proved to be a perfect alternative to help the patient become free from her symptoms, and the calculi could be eliminated completely with Ayurvedic treatments. 

INFORMED CONSENT

Written consent obtained from patient for publishing of the case report in the Portal

ACKNOWLEDGEMENTS

None specified

CONFLICT OF INTEREST

None declared.

FUNDING

None

REFERENCE

1. https://www.mayoclinic.org/diseases-conditions/gallstones/diagnosis-treatment/drc-20354220