Black Pigment Stones Research Articles

β-thalassemia intermedia with autoimmune hemolytic anemia and multiple cholelithiasis complications

The most recommended treatment for β-thalassemia is blood transfusion, but this treatment leads to a number of complications such as iron overload, transfusion reactions, infections, alloimmunization, and formation of autoantibodies. Autoimmune hemolytic anemia (AIHA) in β-thalassemia where alloimmunization reactions occur due to repeated transfusions is an extremely rare complication with only 5% of cases. In this case report, the patient responded well to corticosteroids and cyclosporine. The risk of alloimmunization in patients with β-thalassemia who receive transfusions can be minimized by screening for suitable genotypes, antibodies, and phenotypes prior to transfusion. Meanwhile, cholelithiasis is described as one of the most common complications of thalassemia; of 261 patients, the total prevalence of cholelithiasis was 20.3%. Typical cholelithiasis in thalassemia is black pigment stones. Asymptomatic cholelithiasis does not require treatment as its course and progression to symptomatic disease is relatively low. This case report discusses about a 23-year-old woman with β-thalassemia intermedia who developed complications of AIHA and cholelithiasis.

Gallstones: The thing in itself.

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Study of Bacterial Aetiogenicity of Pigment Gall Stones by Culture of Nidus of Calculus and correlation between Stone Culture and Bile Culture

Background: Calculus disease of biliary tract is a major public health problem in north Kashmir and pigment gall stones form a significant portion of gall stones in our region. In this study we prospectively studied 84 cases of pigment gall stones to examine the role of bacteria in the formation of these stones.
 Objective: To study the bacterial aetiology of pigment gall stones.
 Methods: A hospital based prospective study of 84 consecutive cases of pigment gall stones was done from December 2012 to November 2019 and the results of stone culture and bile culture were statistically analysed. Informed consent was obtained from all the patients in the study group.
 Results: A total of 84 cases studied included 32 (38.09%) male patients and 52(61.91%) females patients. The median age was 48.5 years and mean age was 46.2 years. Of 84 patients, 21(25.00%) had black pigment stones and 63 (75.00%) had brown pigment stones. 61 (72.62%) patients presented with biliary colic and 24(28.57%) patients had chronic cholecystitis . Bile culture was positive in 46 (54.76%) patients and stone culture was positive in 70(83.33%) patients.
 Conlusion: A strong association was observed between stone culture and bile culture results (showing similar beta-glucronidase producing bacteria) and pigment stone formation.

EVALUATION OF TYPES OF GALL STONES AND FACTORS AFFECTING IT.

Introduction: Gallstone (GS) is an important cause of morbidity all over the world. Gallstones are becoming increasingly common and are seen in all age groups. When there is an imbalance in the chemical constituents of bile that result in precipitation of one or more of the components gall stones are formed. In majority of the cases they do not cause symptoms, and about 10% to 20% will eventually become symptomatic within 5 years and 20 years of diagnosis. Gallstones contain mainly cholesterol, bilirubin, and calcium salts, with some amounts of protein and other materials. Pure cholesterol crystals are generally soft, and protein contributes to the strength of cholesterol stones. Pigment stones account for 30 % of gallstones and are divided into black pigment and calcium bilirubinate stones.
 Material and Methods: Demographic characteristics of the patients participating in the study such as age, sex, occupation, lifestyle habits such as alcohol consumption , smoking, sports activity , medication if any used, any diseases, Body mass index (BMI), milk consumption, liver diseases and dietary habits was obtained. Patients were divided into two groups depending upon the type of gall stone either cholesterol or pigment stone.
 Results: A total of 76 patients were included in the present study who underwent cholecystectomy surgery. Age group of more than 51 years showed maximum number of stones in both the groups. Maximum numbers of stones were seen in patients having family history of stones. Patients who were overweight and obsess were having higher incidence of gall stone as compared to normal weight and slim population. Formation of stones in female was more as compared to males.
 Conclusion: Various factors can be considered for the formation of gall stones of which gender, increasing age, genetic factors, dilatory habits, and sedentary lifestyle can be considered as the contributing factors for formation of gall stones and most of them can be prevented by proper education.
 Keywoerds: GS, BMI, liver disease, smoking, alcohol consumption.

Treatment Options for Patients with Gallstones (Cholelithiasis)

According to the Recommendations of the Scientific society of gastroenterologists of Russia for the diagnosis and treatment of cholelithiasis (GI), GI is a multifactorial disease of the hepatobiliary system and one of the most common diseases of the digestive system. It is known that in the vast majority of cases, GI develops as a result of the complex influence of many risk factors. Thus, the change in the qualitative and quantitative composition of bile, as well as a history of gastrectomy, papillosphincterotomy, the right-hand hemicolectomy, cholesterosis gall bladder, chronic hepatitis, peptic ulcer of the duodenum, duodenostasis contributes to the reduction of the contractile function of the gallbladder and the development of hypertonicity of the sphincter of Oddi. Current understanding of mechanisms of formation of gallstones is based on many studies, which proved that the GSD is a result of destabilized bile-damaged hepatocytes, the subsequent nucleation of crystals of monohydrate of cholesterol crystallization in the mucin matrix on the background of hypomotor dysfunction of the gall bladder. After anamnesis and General clinical examination, the main diagnostic method for suspected gastrointestinal tract is ultrasound (ultrasound). However, differentiation of stone types by ultrasound is generally not possible. The most modern diagnostic method is CT with an assessment of the density of stones on the Hounsfield scale. Today, it is common to distinguish three main types of gallstones found in humans: cholesterol, black and brown pigment stones. Methods of treatment of gastrointestinal tract can be divided into invasive or surgical, minimally invasive and non-invasive. Recommending a patient with gastrointestinal surgery, you should always remember that surgical treatment is the elimination of the consequences of cholelithiasis, and not the treatment of its essence. So, after the successful application of udhc in the early 80-ies of the last century for the dissolution of gallstones, drug litholysis, opened a new era in the treatment of gastrointestinal tract and reduced the amount of indications for surgical treatment.

Chronological changes of epidemiologic features of gallstone over last 20years in Korean single large volume center

Introduction: South Korea is one of the prevalent nations of gallstone, which is very common disease around the world. In this study, we aim to investigate the epidemiological characteristics and changing patterns of gallstone over last 20 years in Korea. Method: From 1996 to 2015, 5,808 patients who underwent cholecystectomy due to gallstone in Seoul National University Hospital were analyzed. Patients were divided into four subgroups by time periods: period 1 (1996 to 2000, n=792), period 2 (2001 to 2005, n=1,215), period 3 (2006 to 2010, n=1,525), period 4 (2011 to 2015, n=2,276). Gallstones were classified in to 5 types (pure cholesterol stone, mixed cholesterol stone, calcium bilirubinate stone, black pigment stone and combination stone). Result: Female to male ratio was 1.158 with a mean age of 53.57, 55.25 years old. The ratio of cholesterol stone to pigmented stone was 0.963 : 1(2849 and 2959). The mean age and male to female ratio of patients was increased over time. The proportion of cholesterols vs pigmented stone was no statistically significant difference. In subgroup of gallstones, the proportion of black pigments stone was increased (34.0% to 45.5%), but that of calcium bilirubinate stone was decreased (20.7% to 5.3%). On the aspect of patients’area, calcium bilirubinate stone decreased in both urban and rural area, black pigment stone was increased in both urban and rural area. Conclusion: The number of patients with gallstone was increased. Age and sex of patients and type of gallstone were changed over time. This study can be used as an important reference for epidemiological studies.

A study of etiology and role of bacteria in the pigment gall stone diseases at a tertiary care hospital

Background: Calculus disease of the biliary tract continues to be a significant health problem. Pigment stones are more common in Eastern studies. Predisposing factors such as cirrhosis, ileal resection are commonly seen in the West; while infection as a cause predominates in South East Asia. In this study we prospectively studied Pigment gall stones to examine the causes for and the role of bacteria in pigment Gall stone diseaseMethods: A hospital based prospective study was carried out from January 1992 to December 1994 at Nizam’s Institute of Medical Sciences, Hyderabad. Institutional Ethics Committee permission was taken. Informed consent was obtained from all selected patients. During the study period a total of 25 consecutive patients with Pigment gall stones were analyzed. Details were recorded in a proforma. Stones were collected from the Gall Bladder with aseptic precautions.Results: Total of 25 patients included, wherein 13 (52%) males and 12 (48%) females. The Median age was 55.5 years and the mean age was 50.2 years. Of 25 patients 11 (44%) had black pigment stones and 14 (56%) had brown stones. 22 (88%) patients presented with biliary colic, and 8 (32%) presented with chronic cholecystitis. At surgery 14 (56%) had a thickened wall suggesting inflammation, 7 (28%) had edema. Bile culture was positive in 11 (44%) patients and stone culture in 5 (20%) patient. Twenty two of 25 patients (88%) had evidence of bacteria on electron microscopy.Conclusions: Whether black stones are associated with higher infection rates or bacteria cause black stones – this question probably would never be answered either on the bench or in the clinicians ward. We, however, can definitely say they are intimately related.

Analysis of Carcinogenic Heavy Metals in Gallstones and its Role in Gallbladder Carcinogenesis.

Gallstone is a high-risk factor for gallbladder pre-malignancy or malignancy (GB PM-M) but which substances of gallstones definitely assist to turn out in to GB PM-M, remains unclear. This study aimed to find out the presence of carcinogenic heavy metals in gallstones and to explore the aetiopathogenesis of gallbladder pre-malignancy and malignancy. Presence of elements in gallstones was detected by energy dispersive X-ray spectroscopy (EDS) with scanning electron microscopy (SEM) and then level of carcinogenic heavy metals was estimated in gallstones using atomic absorption spectroscopy (AAS). The experiment was carried out in gallstone samples of 46 patients with gallbladder pre-malignant and malignant condition (PM-M group) and 65 sex and age-matched patients with chronic cholecystitis (C-C group). Gallstones were also classified in to three types such as cholesterol stone, mixed stone, and black pigment stone. EDS analysis detected presence of mercury, lead, and cobalt elements in all types of gallstones of both PM-M and C-C groups. AAS analysis revealed significantly higher amount of mercury (p<0.001), lead (p<0.0001), cobalt (p<0.01), and cadmium (p<0.01) in the gallstones of PM-M than C-C groups. The presence of these heavy metals also varied among stone types of both groups. EDS phase analysis showed 'dense deposits' of these metals in gallstones. Presence of significantly higher amount of mercury, lead, cobalt, and cadmium in gallstones may play a pivotal role as risk factors in the development of gallbladder malignancy or pre-malignancy. 'Dense deposits' of these metals in the gallstones which is the first observation, may act as crucial doses of carcinogens.

Combined microstructural and mineralogical phase characterization of gallstones in a patient-based study in SW Spain - Implications for environmental contamination in their formation

This study explores the environmental impact of metal exposure on humans through detailed phase and structural characterization of gallstones from two environmentally contrasting populations in Huelva Province (SW Spain). A total of 42 gallstone samples, obtained after surgical intervention at the Riotinto Hospital, were studied by powder X-ray diffraction (XRD), Fourier Transformed Infra-Red spectroscopy (FTIR), FTIR-μ-ATR (Attenuated Total Reflection) coupled with an optical microscope, and by Environmental Scanning Electron Microscope with Energy Dispersive X-ray Spectroscopy (ESEM-EDS), and subsequently classified according to their phase composition and structure. Additionally, the patients were enquired for their living habits in order to analyze the source of possible exposure to metal contamination.The gallstones were classified into pure, mixed and composite cholesterol stones, black and brown pigment stones, and carbonate stones. The patients from the study group residing in a region with acknowledged metal contamination of both natural and anthropogenic origin have a higher risk of metal exposure through contaminated soil, particle matter in the air, and consumption of local water and food products. According to our findings, the metal exposure is related to a higher tendency of forming black pigment stones in the study group in comparison to the control group residing in a natural park with nearly pristine environmental conditions. Moreover, the gallstones from the study group showed to contain more abundant metal components, such as Cu, Fe, Ni, and Zn, than those from the control group. To our knowledge this is the first study to examine the regional environmental impact of metal exposure on human gallstones.

Gallstones.

Gallstones grow inside the gallbladder or biliary tract. These stones can be asymptomatic or symptomatic; only gallstones with symptoms or complications are defined as gallstone disease. Based on their composition, gallstones are classified into cholesterol gallstones, which represent the predominant entity, and bilirubin ('pigment') stones. Black pigment stones can be caused by chronic haemolysis; brown pigment stones typically develop in obstructed and infected bile ducts. For treatment, localization of the gallstones in the biliary tract is more relevant than composition. Overall, up to 20% of adults develop gallstones and >20% of those develop symptoms or complications. Risk factors for gallstones are female sex, age, pregnancy, physical inactivity, obesity and overnutrition. Factors involved in metabolic syndrome increase the risk of developing gallstones and form the basis of primary prevention by lifestyle changes. Common mutations in the hepatic cholesterol transporter ABCG8 confer most of the genetic risk of developing gallstones, which accounts for ∼25% of the total risk. Diagnosis is mainly based on clinical symptoms, abdominal ultrasonography and liver biochemistry tests. Symptoms often precede the onset of the three common and potentially life-threatening complications of gallstones (acute cholecystitis, acute cholangitis and biliary pancreatitis). Although our knowledge on the genetics and pathophysiology of gallstones has expanded recently, current treatment algorithms remain predominantly invasive and are based on surgery. Hence, our future efforts should focus on novel preventive strategies to overcome the onset of gallstones in at-risk patients in particular, but also in the population in general.

Relation of cholesterol metabolism to pediatric gallstone disease: a retrospective controlled study.

BackgroundCholesterol metabolism may be involved in pediatric gallstone disease. We aimed to reveal cholesterol metabolites and phytosterols and their relation to stone composition of sterols in children having black pigment and cholesterol stones.MethodsWe performed retrospective controlled clinical study, in which we examined parameters of cholesterol metabolism and liver function values in serum (n = 28) and gallstones (n = 46) of consecutively cholecystectomized children. Serum values of age-, body mass index- and sex-matched children (n = 82) and adult gallstones (n = 187) served as controls.ResultsSurrogate markers of cholesterol synthesis in serum (squalene/cholesterol, cholestenol/cholesterol and lathosterol/cholesterol) were 26–52 % higher in both stone subclasses compared to controls (p < 0.05 for all). Respectively, cholestanol/cholesterol and plant sterols campesterol/cholesterol and sitosterol/cholesterol (cholesterol absorption markers) had decreasing order in serum: black pigment stone group > controls > cholesterol stone group (p < 0.05 for all). In black pigment stone group, stone cholestanol/cholesterol was associated with serum bile acids (r = 0.620, p = 0.018). In cholesterol stone group, surrogate markers of cholesterol synthesis in serum (e.g., lathosterol/cholesterol) inversely reflected those of absorption (r-range -0.633–-0.706, p-range 0.036–0.015). In cholesterol stone group, serum and stone lathosterol/cholesterol and cholestanol/cholesterol were positively interrelated (r-range 0.727–0.847, p < 0.05 for both).ConclusionsGallstone subclasses shared enhanced cholesterol synthesis. Cholesterol stone children were low cholesterol absorbers with intact homeostasis of cholesterol metabolism. Black pigment stone group was characterized by deteriorated cholesterol metabolism, and accumulation of cholestanol, campesterol and sitosterol in serum and stones suggesting their participation in pathogenesis.

Gallstones in New Zealand: composition, risk factors and ethnic differences

Gallstone disease is a worldwide problem causing morbidity, mortality and a drain on health-care resources. This prospective study aimed to investigate the spectrum of gallstone types in New Zealand and relate these to known risk factors. Gallstone samples were collected from 107 patients undergoing surgery for gallstone disease at Auckland City Hospital between June 2009 and June 2010. Detailed chemical analyses were performed using Fourier Transform Raman spectroscopy. The relationship between gallstone type and age, gender, ethnicity, obesity and positive family history were analysed. Median age was 51 years (range 19-88), 75 (70%) were female, one third were obese (body mass index ≥ 30) and 41% had a positive family history. Major ethnic groups were European (51%), Asian (23%) and Māori/Pacific (18%). Gallstone types included pure or mixed cholesterol stones (74%), black pigment stones (20%) and brown pigment stones (5%). Asians had a higher proportion of black pigment stones and NZ Europeans had more cholesterol and mixed cholesterol stones (odds ratio 3.6 (95% CI 1.1 to 11.5)). The frequency of cholesterol/mixed cholesterol stones was not significantly different between NZ Europeans and Māori/Pacific groups (P = 0.7). Black pigment stones were more common in older patients (mean 68.0 years compared with 47.6 for cholesterol/mixed cholesterol stones) (P = 0.0001). There was no significant relationship between stone type and family history (P = 0.16) or gender (P = 0.17). This novel prospective study highlights risk factors and ethnic differences in gallstone composition in New Zealand. These may be important when considering gallstone prevention strategies.

Epidemiology of Gallbladder Disease: Cholelithiasis and Cancer

Diseases of the gallbladder are common and costly. The best epidemiological screening method to accurately determine point prevalence of gallstone disease is ultrasonography. Many risk factors for cholesterol gallstone formation are not modifiable such as ethnic background, increasing age, female gender and family history or genetics. Conversely, the modifiable risks for cholesterol gallstones are obesity, rapid weight loss and a sedentary lifestyle. The rising epidemic of obesity and the metabolic syndrome predicts an escalation of cholesterol gallstone frequency. Risk factors for biliary sludge include pregnancy, drugs like ceftiaxone, octreotide and thiazide diuretics, and total parenteral nutrition or fasting. Diseases like cirrhosis, chronic hemolysis and ileal Crohn's disease are risk factors for black pigment stones. Gallstone disease in childhood, once considered rare, has become increasingly recognized with similar risk factors as those in adults, particularly obesity. Gallbladder cancer is uncommon in developed countries. In the U.S., it accounts for only ~ 5,000 cases per year. Elsewhere, high incidence rates occur in North and South American Indians. Other than ethnicity and female gender, additional risk factors for gallbladder cancer include cholelithiasis, advancing age, chronic inflammatory conditions affecting the gallbladder, congenital biliary abnormalities, and diagnostic confusion over gallbladder polyps.

Influence of Black and Brown Pigment Stone in Cholecystectomized Patients With Acute Biliary Pancreatitis.

BackgroundBiliary tract stones account for the majority of cases with acute pancreatitis, and include black and brown pigment stones. The aim of the study was to compare the presentation and outcome in cholecystectomized patients with acute biliary pancreatits caused by black and brown pigment stones.MethodData from patients with prior cholecystectomy and acute biliary pancreatitis were collected from January 2009 to August 2011. These cases were assigned to black or brown pigment stone groups according to the stone pattern. The general data, laboratory data, image findings and outcomes of the two groups were collected and analyzed.ResultsA total of 98 enrolled patients, with 30 (30.6%) and 68 cases (69.4%) assigned to the black and brown pigment stone groups, respectively. The cases with black pigment stone had higher CT Severity Index scores, bilirubin, ALP, ALT, rates of cholangitis, and positive blood culture. In those with brown pigment stone, there was a higher number of ERCP evaluations performed.ConclusionCholecystectomized cases with biliary pancreatitis due to black pigment stone had a higher prevalence of laboratory cholestasis and a higher rate of cholangitis.

Color Doppler Twinkling Artifacts from Gallstones: In Vitro Analysis Regarding their Compositions and Architectures

The purpose of our study was to investigate the relationship between a twinkling artifact and the biochemical compositions of gallstones in phantom experiments. Fifty-two gallstones surgically extracted from 26 patients (26 cholesterol, 12 brown pigment and 14 black pigment stones) were included in the phantom study. Color Doppler sonography was performed to evaluate the occurrence of a twinkling artifact behind the stones. The artifacts were graded from grade 0 (no artifact) to grade 3 (very strong artifact). Micro computed tomography (CT) images were obtained to analyze the internal architecture and external surface of the stones. A total of 20 of 26 cholesterol stones (77%) produced grade 2 or 3 artifacts, whereas almost all the black pigment stones and more than half of the brown pigment stones produced no artifacts or grade 1 artifacts ( p = 0.0010). The sensitivity and specificity of grade 2 or greater artifacts for cholesterol stones were 76.9% and 76.9%, respectively. The composition of the stones was strongly correlated with the internal shape on the micro CT image. Cholesterol stones with rough surfaces did not show stronger intensities of the artifacts than those with smooth surfaces ( p > 0.05). In conclusion, most of the prominent artifacts arose from cholesterol stones having radial or radial-concentric internal architectures, whereas the black pigment stones mostly produced little artifact. (E-mail: leejy4u@snu.ac.kr)

Cholesterol, non-cholesterol sterols and bile acids in paediatric gallstones

Depending on underlying aetiopathogenetic factors human gallstones contain various amounts of cholesterol, non-cholesterol sterols and bile acids, which have remained unexplored in paediatric gallstone patients. To evaluate sterol and bile acids compositions of paediatric gallstones. Study group included 21 consecutively cholecystectomised children. Gas-liquid chromatography was used to quantitate gallstone sterols and bile acids. Results were compared to adult gallstones (n=194). Cholesterol stones (n=9) had higher proportions of cholesterol and lathosterol, but lower those of lanosterol and phytosterols than pigment stones (n=12) (p<0.05 for each). Patients with gallstone cholesterol content over 70% were female. Gallstone cholesterol positively reflected body mass index and, in cholesterol stones-group, age (r=approximately +0.700, p<0.05). Three patients on parenteral nutrition had brown pigment stones consisting of high amounts of campesterol and sitosterol ranging 483-9303 microg/100 mg of stone. Pigment stones had 13-fold higher amount of bile acids than cholesterol stones (p<0.05). Black pigment stones contained approximately 3-fold higher phytosterol proportions, and pigment stones and cholesterol stones had approximately 43% lower proportions of deoxycholic acid than adults (p<0.05). Gallstones in patients on parenteral nutrition are rich in phytosterols. With respect to gallstone sterols, gallstone disease of adolescent girls resembles that of adults. Composition of bile acids in paediatric gallstones is different from adults.

15 Decreased Postprandial Gallbladder Emptying in Patients with Black Pigment Stones: A Comparative Study in Patients with Cholesterol Stones and Normal Subjects

15 Decreased Postprandial Gallbladder Emptying in Patients with Black Pigment Stones: A Comparative Study in Patients with Cholesterol Stones and Normal Subjects

Composition of gallbladder and bile duct calculi

The composition of gallbladder and bile duct stones removed at the time of cholecystectomy was analysed in a consecutive series of 45 patients. The type of stones at the two sites was similar in all but two patients. Cholesterol content differed by more than 20% in only six patients. Cholesterol stones were found in the gallbladder of 33 patients, in the bile duct of 36 patients (73 and 80%, respectively); mixed stones in eight and five patients, respectively (18 and 11%); brown-pigment stones in three patients each (7%); black-pigment stones in one patient each (2%). Bile duct stones overlooked during cholecystectomy are thus suitable for litholysis, e.g. by irrigation with monooctanoin, in the majority of cases.

Decreased postprandial gallbladder emptying in patients with black pigment stones

To analyze gallbladder contractility in patients with black pigment stones (BPSs) and to compare this with patients with cholesterol stones (CSs) and healthy volunteers. The pattern of bile evacuation from the gallbladder was quantified by computer cholescintigraphy in 28 normal subjects, 22 patients with CSs and 14 with BPSs. The parameters of gallbladder contractility included ejection period (EP), ejection fraction (EF) and ejection rate (ER). A significantly shorter EP was observed in patients with BPSs in comparison to those with CSs (t = 2.4, P < 0.05). EF in BPS patients significantly decreased in comparison to that in CS and normal subjects (t = 6.4, P < 0.0001; t = 2.1, P < 0.05). EF in CS patients also significantly decreased in comparison to that in normal subjects (t = -3.0, P < 0.005). Consequently, ER in patients with BPSs and CSs was significantly smaller than that in normal subjects (t = 3.1, P < 0.005; t = -3.5, P < 0.001). Moreover, in cases where postprandial reflux of a radioisotope into the common hepatic duct from the gallbladder was observed, EF and ER of either CS or BPS patients showed a significant reduction. Bile evacuation from the gallbladder is reduced in patients with BPSs, in comparison to those with CSs and to healthy volunteers. Bile stagnation due to impaired gallbladder kinetics seems to be one of the predisposing factors for the development of BPSs.

Calcium carbonate gallstones in children

Background In the United States, cholesterol stones account for 70% to 95% of adult gallstones and black pigment stones for most of the remainder. Calcium carbonate stones are exceptionally rare. A previous analysis of a small number of pediatric gallstones from the north of England showed a remarkably high prevalence of calcium carbonate stones. The aims of this study were to analyze a much larger series of pediatric gallstones from our region and to compare their chemical composition with a series of adult gallstones from the same geographic area. Methods A consecutive series of gallbladder stones from 63 children and 50 adults from the north of England were analyzed in detail using Fourier transform infrared microspectroscopy. Demographic and clinical data were collected on all patients. The relative proportions of each major stone component were assessed: cholesterol, protein and calcium salts of bilirubin, fatty acids, calcium carbonate, and hydroxyapatite. Results Thirty-nine (78%) adults had typical cholesterol stones, 7 (14%) had black pigment bilirubinate stones, and only 2 (4%) had calcium carbonate stones. In contrast, 30 (48%) children had black pigment stones, 13 (21%) had cholesterol stones, 15 (24%) had calcium carbonate stones, 3 (5%) had protein dominant stones, and 2 (3%) had brown pigment stones. In children, cholesterol stones were more likely in overweight adolescent girls with a family history of gallstones, whereas black pigment stones were equally common in boys and girls and associated with hemolysis, parenteral nutrition, and neonatal abdominal surgery. Calcium carbonate stones were more common in boys, and almost half had undergone neonatal abdominal surgery and/or required neonatal intensive care. Conclusion The composition of pediatric gallstones differs significantly from that found in adults. In particular, one quarter of the children in this series had calcium carbonate stones, previously considered rare. Geographic differences are not the major reason for the high prevalence of calcium carbonate gallstones in children.