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May 1989, Vol 124, No. 5 >
ARTICLE | May 1989

Gallstone Disease:  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. doi:10.1001/archsurg.1989.01410050119023.
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• 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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