Gallstone disease. The clinical manifestations of infectious stones.
Gallstones from 82 patients were examined under a scanning electron microscope for evidence of bacteria, and the findings were compared with the clinical manifestations of the disease. Bacteria were present in 68% of pigment stones and the pigment portions of 80% of composite stones. These gallstones were referred to as infectious stones. No bacteria were found in cholesterol gallstones. Acute cholangitis was diagnosed in 52% of patients with infectious stones and in 18% of patients with noninfectious stones. Over half of the patients with noninfectious stones presented with mild symptoms. Infectious stones were more often associated with a previous common duct exploration, an urgent operation, infected bile, a common duct procedure, and complications. These data show that gallstone disease is more virulent in patients whose gallstones contain bacteria.
Smith
A L
AL
Surgical Service, Veterans Administration Medical Center, San Francisco, CA 94121.
Stewart
L
L
Fine
R
R
Pellegrini
C A
CA
Way
L W
LW
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001419:Bacteria / Q000302:isolation & purification*; D002761:Cholangitis / Q000209:etiology*; D002769:Cholelithiasis / Q000032:analysis / Q000150:complications / Q000382:microbiology*; D002784:Cholesterol / Q000032:analysis; D005260:Female; D042882:Gallstones / Q000382:microbiology; D006801:Humans; D008297:Male; D008855:Microscopy, Electron, Scanning; D008875:Middle Aged; D010860:Pigments, Biological / Q000032:analysis
D010860:Pigments, Biological; D002784:Cholesterol