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The statement so frequently made that gall-stones, in a large percentage of cases, produce no symptoms, is misleading and requires some qualification. It is true that they are often found during operation or post mortem when their presence has not been suspected, but in most cases symptoms were present, and were attribuuted to disease of some organ other than the gall-bladder, usually the stomach or duodenum and sometimes the appendix.
Recognition of this fact has induced some authors to group cases in two classes: (1) those giving direct symptoms, unmistakably indicating gall-bladder disease; (2) the group presenting indirect symptoms referred to other organs. It is to the group presenting symptoms of uncertain meaning that attention is invited, because it is in this class that difficulty is especially apt to be encountered in establishing a correct diagnosis.
A brief reference to the embryology and physiology of the organs involved may explain
MALLORY WJ. THE DIFFERENTIAL DIAGNOSIS OF CHOLELITHIASIS FROM GASTRIC AND DUODENAL ULCER. JAMA. 1914;LXII(4):263-265. doi:10.1001/jama.1914.02560290013004