DOI: http://dx.doi.org/10.18203/2349-2902.isj20185037

A study of etiology and role of bacteria in the pigment gall stone diseases at a tertiary care hospital

Rajendra Desai, Earnest Daniel Prasad, Satyanarayana G., Lakshmi V., Nayana Joshi

Abstract


Background: Calculus disease of the biliary tract continues to be a significant health problem. Pigment stones are more common in Eastern studies. Predisposing factors such as cirrhosis, ileal resection are commonly seen in the West; while infection as a cause predominates in South East Asia. In this study we prospectively studied Pigment gall stones to examine the causes for and the role of bacteria in pigment Gall stone disease

Methods: A hospital based prospective study was carried out from January 1992 to December 1994 at Nizam’s Institute of Medical Sciences, Hyderabad. Institutional Ethics Committee permission was taken. Informed consent was obtained from all selected patients. During the study period a total of 25 consecutive patients with Pigment gall stones were analyzed. Details were recorded in a proforma. Stones were collected from the Gall Bladder with aseptic precautions.

Results: Total of 25 patients included, wherein 13 (52%) males and 12 (48%) females. The Median age was 55.5 years and the mean age was 50.2 years. Of 25 patients 11 (44%) had black pigment stones and 14 (56%) had brown stones. 22 (88%) patients presented with biliary colic, and 8 (32%) presented with chronic cholecystitis. At surgery 14 (56%) had a thickened wall suggesting inflammation, 7 (28%) had edema. Bile culture was positive in 11 (44%) patients and stone culture in 5 (20%) patient. Twenty two of 25 patients (88%) had evidence of bacteria on electron microscopy.

Conclusions: Whether black stones are associated with higher infection rates or bacteria cause black stones – this question probably would never be answered either on the bench or in the clinicians ward. We, however, can definitely say they are intimately related.


Keywords


Black stones, Gall stones, Infection rates, Pigment stones

Full Text:

PDF

References


Channa NA, Khand FD, Khand TU, Leghari MH, Memon AN. Analysis of human gallstone by fourier transform infrared (FTIR). Pak J Med Sci. 2007;23:546–50.

Bouchier TA. Gallstones. Proc R Soc Med. 1977;70:597–9.

Berci G. Historical overview of surgical treatment of biliary stone disease. In: MacFadyen BV, Arregui M, Eubanks S, Olsen DO, Peters JH, Soper NJ, et al., editors. Laparoscopic Surgery of the Abdomen. New York: Springer; 2004:139-142.

Gordon-Taylor G. On gallstones and their sufferers. Br J Surg. 1937;25:241-51.

Hadidy S, Turki J, Misri HT. Cholelithiasis in the Syrian population. A prospective study of 189 patients. Am J Surg. 1987;153:392-3.

Trotman BW. Pigment gallstone disease. Gastroenterol Clin North Am. 1991;20(1):111-26

Izumi K. Studies on the chemical composition of gallbladder bile and gall stones; especially on the difference in the process of gallstone formation between cholesterol stones and bile pigment stones. Fukuoka Acta Med. 1965;56:488-523.

Maki T. Pathogenesis of calcium bilirubinate gallstones: role of E.coli, beta-glucuronidase and coagulation by inorganic ions, polyelectrolytes and agitation. Ann Surg. 1966;164:90-100.

Trotman BW, Ostrow JD, Soloway RD. Pigment vs. Cholesterol cholelithiasis: comparison of stone and bile composition. Am J Dig Dis. 1974;19:585-90.

Bouchier IAD. Postmortem study of the frequency of gallstones in patients with cirrhosis of the liver. Gut 1969;10:705-10.

Trotman BW, Soloway RD. Pigment vs. Cholesterol cholelithiasis: clinical and epidemiological aspects. Am J Dig Dis. 1975;20:735-40.

Stewart L, Oesterle AL, Erdan I, Griffiss JM, Way LW. Pathogenesis of pigment gallstones in Western societies: the central role of bacteria. J Gastrointest Surg. 2002;6(6):891-903.