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May 1989

Gallstone Disease: The Clinical Manifestations of Infectious Stones

Author Affiliations

From the Surgical Service, Veterans Administration Medical Center, and the Department of Surgery, University of California, San Francisco.

Arch Surg. 1989;124(5):629-633. doi:10.1001/archsurg.1989.01410050119023

• 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.

(Arch Surg 1989;124:629-633)

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