Primary “Brown Pigment” Bile Duct Stones

Luis Vitetta,Peter Little,Ayman Elzarka,Avni Sali,Jack Nayman

doi:10.1155/1991/76160

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.

Highlights

In 1924 Aschoff described in detail, the morphol6gical features of a "primary biliary stasis stone", whose origin was in the bile ducts
The bile duct stones from 27 patients were classified as primary bile duct stone (PBDS) from their morphology (Table 1)
Examination of the gross morphology of "soft" calculi obtained from the bile ducts of 27 patients, suggested that such calculi had unique morphological features not observed in gallstones

Summary

Introduction

In 1924 Aschoff described in detail, the morphol6gical features of a "primary biliary stasis stone", whose origin was in the bile ducts. The concept of the stasis stone or brown pigment stone in the bile ducts has developed into a distinct entity, with specific anatomical locus and pathology. Animal models2’3 have demonstrated that common duct and hepatic/intrahepatic duct stones form as a result of common duct obstruction and stasis. It has been suggested that common bile duct calculi result from chemical changes in the bile composition4’5 with or without infection2’3. Mechanical aberrations, such as a diverticulum of the common duct, long cystic duct remnants and suture material from previous surgery, all favour the formation of primary bile duct stones4’6

Methods

Results

Conclusion