Primary “Brown Pigment” Bile Duct Stones

Abstract

Bile duct stones from 42 patients were morphologically and chemically analysed. The calculi from 27 patients had important primary bile duct stone (PBDS) features, consisting of a general ovoid shape and fragile structure, with alternating light and dark brown pigmented layers on cross-section. Chemically these stones contained low levels of cholesterol, with high levels of bilirubin and calcium. Subsequent infrared spectroscopy analysis showed that calcium bilirubinate and calcium palmitate were the only calcium salts present. Calcium palmitate was prominent in the light brown layers. A morphological and chemical comparison with gallbladder stones showed that bile duct "stasis stones" were similar in morphological and chemical composition to the brown pigment gallbladder calculi. However, they were distinct from most gallbladder stones, indicating that primary bile duct calculi have an aetiology that is different to 90% of gallbladder calculi. Primary bile duct calculi were observed to occur with or without the presence of a gallbladder, and more interestingly, in the bile duct of two patients with cholesterol gallbladder stones. Bile duct bile of patients with primary choledocholithiasis were always moderately to profusely infected and with abundant calcium bilirubinate precipitation. Moreover, this study has shown that PBDS chemical analyses profiles were consistent and correlated well with their defined morphology. Consequently, PBDS may be accurately identified at the time of operation by morphology. An important aetiological factor would appear to be infection, which would seem to promote bile duct bile stasis and eventual stone growth.

Melatonin Prevents Pigment Gallstone Formation Induced by Bile Duct Ligation in Guinea Pigs

“…The induced pigment sludge and stone were therefore mainly a result of stasis and nonenzymatic hydrolysis of conjugated bilirubins. 15 Although guinea pig bile is quite different from human bile in the concentrations of bilirubin and lipid and in the proportions of bilirubin monoglucuronide and bilirubin diglucuronide, the induced pigment sludge and gallstones in our ligated animals were chemically and morphologically similar to the pigment stone in humans, 15,[26][27][28] indicating that the pathogenesis may be the same. Therefore, it is justified to use this animal model to study the effect of oxidative stress in the pathogenesis of pigment gallstone formation.…”

Gallstones and Gall Bladder Carcinoma

“…Chemical analysis including infrared spectroscopy analysis was performed according to methods previously described elsewhere. [50][51][52][53][54] Gall bladder bile was aspirated from the gall bladder prior to making an incision to remove the gallstones. Total bile salts, phopholipids and cholesterol were estimated on all bile samples obtained at surgery according to previously reported methods.…”

“…This cohort consists of a series of patients that began in 1980 at the University Department of Surgery Repatriation General Hospital Heidelberg in Melbourne and which extended to 1994. Various aspects of biliary disease have been previously published in part from this cohort [50][51][52][53][54] and relevant methodological issues will not be repeated except to refer to these reports.…”

Hypothyroidism as a risk factor for choledocholithiasis: A case-control study in an Indian population

“…Behavioral factors associated with cholesterol gallstones include nutrition, obesity, weight loss, and physical activity [5] . Biologic factors linked to gallstones include increasing age, female sex and parity, serum lipid levels, and the Native American, Chilean and Hispanic race [6] . Primary bile duct stones, on the other hand, form within the bile ducts and usually are of the brown pigment variety, tend to be lower in cholesterol content and higher in bilirubin content as compared with secondary stones [7,8,9] .…”