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The Clinical Manifestations of Infectious Stones

Alison L. Smith, MD; Lygia Stewart, MD; Robert Fine, MD; Carlos A. Pellegrini, MD; Lawrence W. Way, MD

Arch Surg. 1989;124(5):629-633.

Abstract
• 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)

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

Footnotes
Accepted for publication Nov 7, 1988.

Read before the 59th Annual Meeting of the Pacific Coast Surgical Association, San Francisco, Feb 24, 1988.

Reprint requests to Surgical Service (112), Veterans Administration Medical Center, 4150 Clement St, San Francisco, CA 94121 (Dr Way).

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