Gallstones

Background Acute pancreatitis is a common, yet complex, emergency surgical presentation. Multiple guidelines exist and management can vary significantly. The aim of this first UK, multicentre, prospective cohort study was to assess the variation in management of acute pancreatitis to guide resource planning and optimize treatment. Methods All patients aged greater than or equal to 18 years presenting with acute pancreatitis, as per the Atlanta criteria, from March to April 2021 were eligible for inclusion and followed up for 30 days. Anonymized data were uploaded to a secure electronic database in line with local governance approvals. Results A total of 113 hospitals contributed data on 2580 patients, with an equal sex distribution and a mean age of 57 years. The aetiology was gallstones in 50.6 per cent, with idiopathic the next most common (22.4 per cent). In addition to the 7.6 per cent with a diagnosis of chronic pancreatitis, 20.1 per cent of patients had a previous episode of ...

Unusual clinical course Background: Biliointestinal bypass is a malabsorptive procedure for surgical treatment of morbid obesity. It is the evolution of jejunoileal bypass, and it is characterized by a cholecysto-jejunostomy on the proximal end of the excluded jejunum, therefore, allowing bile flow through the excluded bowel loop reducing the risk of postoperative diarrhea and malabsorption syndrome. Obesity is a well-known risk factor for cholelithiasis; moreover, bariatric surgery has been showed to increases the risk of gallstones formation. Case Report: A 48-years-old male (body mass index 42 kg/m 2) received a laparoscopic biliointestinal bypass. Nine years later, the patient received a cholecystotomy for removal of biliary stones. No surgical procedures were performed on the cholecysto-jejunostomy. Fourteen years after the bariatric treatment, the patient underwent enterolithotomy after a diagnosis of gallstone ileus. The impacted biliary stone was documented in the excluded loop proximal to the anti-reflux valvular system. The postoperative course and 1-year follow-up were uneventful. Conclusions: Few cases of gallstone ileus following biliointestinal bypass have been described in the literature. We report a new case and also propose few tips and tricks for cholelithiasis and gallstone ileus prevention after biliointestinal bypass.

Gallstone ileus is rare following an Endoscopic Retrograde Cholangio-Pancreaticography (ERCP). We present a case where gallstones caused ileus and perforation of small bowel after a therapeutic ERCP. There was no previous history of instrumentation of the papilla or a cholecystoenteric fistula. This case points out a serious morbidity of therapeutic ERCP for large common bile duct stones.

Gallstones Disease (GSD) is one of the most common digestive diseases requiring hospitalization and surgical procedures in the world. GSD has a high prevalence in populations with European or Amerindian ancestry (10-20%) and the influence of genetic factors is broadly acknowledged. However, known genetic variants do not entirely explain the disease heritability suggesting that additional genetic variants remain to be identified. Here, we examined the association of copy number variants (CNVs) with GSD in a sample of 4778 individuals (1929 GSD cases and 2849 controls) including two European cohorts from Germany (n = 3702) and one admixed Latin American cohort from Chile (n = 1076). We detected 2936 large and rare CNVs events (size > 100 kb, frequency < 1%). Case-control burden analysis and generalized linear regression models revealed significant association of CNVs with GSD in men, with the strongest effect observed with CNVs overlapping lipid metabolism genes (p-value = 6.54 × 10-4 ; OR = 2.76; CI 95% = 1.53-4.89). Our results indicate a clear link between CNVs and GSD in men and provides additional evidence that the genetic components of risk for GSD are complex, can be sex specific and include CNVs affecting genes involved in lipid metabolism.

from January 2002 to December 2004. METHOD: The data of 45 consecutive patients admitted with acute pancreatitis was collected through a proforma and assessed with reference to aetiological factors, clinical presentation and management in each case. RESULTS: Majority (60%) of the patients belonged to 30-40 years of age. Thirty-six (80%) patients presented in emergency. The most common aetiological factor for acute pancreatitis was gallstones and the pain, nausea and vomiting were the main symptoms. Serum amylase (>3 x normal) was seen in 36(80%) patients. Prediction of severity was identified through Ranson score. It was <3 in 27(60%), 3 in 13(28.9%) and 4 in 5(11.1%) patients. The mortality was 13.33% but the morbidity remained high with the sequelae of resolution in >50% cases. CONCLUSION: Acute pancreatitis in our set up shows a lower frequency of this disease when compared to the world literature. However, when compared with aetiology and presentation, the pattern remains the same. Meanwhile, due to adoptation of Western way of life, the incidence seems to be increasing. Due to patient's delayed arrival, the diagnosis depending upon the level of serum amylase seems to be misleading.

Hepatitis E virus (HEV) is an enteric virus that usually causes a self-resolving hepatitis; although, it may be fatal, especially in pregnant women. Although HEV is endemic in Israel, there have been no recent local outbreaks. We report the case of a 70-year-old man who presented with painless jaundice. Ultrasound and abdominal computed tomography scan revealed gallstones, with no evidence of cholecystitis and no dilatation of the intra-or extrahepatic bile ducts. An open cholecystectomy was performed with intraoperative cholangiography. There was no evidence of choledocholithiasis. A subsequent endoscopic retrograde cholangiopancreatography was normal. His bilirubin level subsequently increased to a maximum of 25 mg/dL, and his gamma-glutamyltransferase level reached 1,400 U/L. There was no evidence of any autoimmune or metabolic disease, and routine viral serology was normal except for immunoglobulin G to hepatitis A virus. A liver biopsy revealed an acute cholestatic picture. The jaundice resolved slowly after a period of 6 months. Hepatitis E virus RNA was isolated from the acute-phase serum and was not detectable in the convalescent serum. This case is a unique example of chronic cholestatic jaundice that we think is caused by acute HEV infection.

Choledochocele or type III choledochal cyst is a very rare lesion, defined as a cystic dilatation of the distal common bile duct protruding into the duodenal lumen. Abdominal pain, biliary disorders, and acute pancreatitis are frequently observed but malignant degeneration is rare. A 70-year-old man had a history of epigastralgia associated with abnormal liver function tests suggesting gallstones. During laparoscopic cholecystectomy, intraoperative cholangiography showed a 40-mm-diameter choledochocele associated with choledocholithiasis. A transcystic drain was placed after cholecystectomy had been completed. Endoscopic retrograde cholangiopancreatography confirmed the diagnosis and a 45-mmlong endoscopic sphincterotomy successfully treated both lesions as confirmed by a transcystic cholangiogram showing a thin-walled common bile duct with no residual stones. This case illustrates that the diagnosis of choledochocele remains difficult in clinical practice and confirms that endoscopic retrograde cholangiopancreatography is the best available diagnostic tool. Coexistent choledocholithiasis is observed in about 20% of choledochocele. Endoscopic sphincterotomy is feasible and effectively treats both lesions even in larger choledochoceles.

Background The prognostic and pathophysiologic significance of the biliary microbiota in pancreaticobiliary malignancies is little understood. Our goal was to find malignancy-related microbiomic fingerprints in bile samples taken from patients with benign and malignant pancreaticobiliary diseases. Methods Bile specimens were collected from consenting patients during routine endoscopic retrograde cholangiopancreatography. We used PowerViral RNA/DNA Isolation kit to extract DNA from bile specimens. The Illumina 16S Metagenomic Sequencing Library Preparation guide was used to amplify the bacterial 16S rRNA gene and create libraries. QIIME (Quantitative Insights Into Microbial Ecology), Bioconductor phyloseq, microbiomeSeq, and mixMC packages were used for post-sequencing analysis. Results Of 46 enrolled patients, 32 patients had pancreatic cancers, 6 had cholangiocarcinoma and 1 had gallbladder cancer. Rest of the patients had benign diseases including gallstones, and acute and chronic pancreatitis. We used multivariate approach in mixMC to classify Operational Taxonomic Units (OTUs). Doing this, we found a predominance of genera Dickeya (p = 0.00008), [Eubacterium] hallii group (p = 0.0004), Bacteroides (p = 0.0006), Faecalibacterium (p = 0.006), Escherichia-Shigella (p = 0.008), and Ruminococcus 1 (p = 0.008) in bile samples from pancreaticobiliary cancers as compared to benign diseases. Additionally, bile

Choledocholithiasis has been found in about 5% to 20% of the approximately 20 million Americans with cholelithiasis who have undergone cholecystectomy. We report a case of a 64-year-old woman who developed gallstones after undergoing a cholecystectomy >40 years earlier. The potential of retained gallstones, incomplete gallbladder removal, or regeneration of gallstones in the gallbladder remnant or cystic duct remnant after a long time following cholecystectomy is discussed.

Background: Gallstones are a significant global health issue, imposing enormous costs to patients and the healthcare system, annually. Objectives: This epidemiological study aimed to explore the prevalence of gallstones among inpatients who were admitted to Shahid Rahimi Hospital in Khorramabad City, Iran, from 2016 to 2020. Methods: This was a retrospective and descriptive-analytical study. The study population included patients who were admitted to Shahid Rahimi Hospital in Khorramabad City, Iran, who underwent abdominal ultrasounds from 2016 to 2020. The required data were collected using a checklist and patients' records. The logistic regression analysis method was used to analyse the obtained data in SPSS at the significance level of P<0.05. Results: Of the 927 explored subjects, 232(25%) presented gallstones. The mean age of the patients with gallstones was 62.9 years. The most frequent symptom in individuals with gallstones was right upper quadriceps abdominal pain (63%). There was a significant relationship between gallstone and age, gender, epigastric pain, upper quadrant pain, hypertension, anemia, and family history. Conclusion: The present study findings indicated that increasing age, female gender, the lack of epigastric pain, upper quadrant pain, anemia, hypertension, and a family history of this disease increased the risk of generating gallstone disease.

Background: Gallstones are the major cause of morbidity and mortality throughout the world. With at least 10 % of the adults have gallstones with a recent rise in the incidence due to change in the dietary factors. This study intends to know its various modes of presentation, treatment, and outcome.Methods: Fifty patients with symptoms and signs of cholelithiasis were included in the study, clinical profile, investigation, treatments, outcomes were analyzed.Results: The highest age incidence of cholelithiasis was in the 5th decade, more common in females. Pain abdomen was the most common symptom. Ultrasonography showed gallbladder stones in all patients and 52% of patients undergone open cholecystectomy, 48% of patients undergone laparoscopic cholecystectomy. The conversion rate of lap to open cholecystectomy was 4%. The operating room time and the length of post operative stay were 65 min and 7 days in open cholecystectomy and 115 min and 3 days in lap cholecystectomy.Conclusions: ...

Background: Gallstones are one of the widely occurring digestive/hepatobiliary disorders. Chronic cholecystitis, cholelithiasis or symptomatic gallbladder is a prolonged mechanical or functional disorder of abnormal gallbladder emptying. Nearly eighty percent of the gallstones are cholesterol gallstones, and 20% are pigmented stones consisting of bilirubin and calcium, the two components present in the bile. The diagnosis is established by a variety of diagnostic tools like ultrasonography, CT scan, ERCP, liver function tests and pancreatic enzyme studies. The hypothesis of the presence of H. pylori in the biliary epithelium of the patients with hepatobiliary ailments has been sporadically investigated. Helicobacter pylori (H. pylori) is a spiral, microaerophilic, gram-negative bacterium. There are many suggestive evidences that the DNA components of H. pylori is found in the bile, gallbladder tissue and/or cholesterol gallstones. The association of gallstones with Helicobacter pylori has been investigated by many authors, but not clearly established. Methods: The present study is aimed to identify the Helicobacter pylori infection as a risk factor for gallstone disease. The histopathological samples of gall bladder mucosa were examined by staining with modified giemsa stain, haematoxylin, and eosin. Results: Our study showed the presence of H. pylori in only one case which is not statistically significant. Moreover, the present study was based on H and E stains only and they should have been substantiated with immunohistochemistry and PCR studies. Thus, further studies are required to establish a causal relationship between the Helicobactor pylori infection and gallstone formation. Conclusions: Helicobacter pylori as a risk factor for gallstones is yet to be proven.

Background: Endoscopic biliary stenting is often used for large or difficult common bile duct (CBD) stones, but the effect of indwelling endoprosthesis on size or fragmentation of stones after long-term treatment with biliary stenting has not been formally established. We compared the stone size or fragmentation of common bile duct stones after a long period of biliary stenting. Methods: Endoscopic biliary endoprosthesis was performed for 49 high-risk patients with CBD stones too large or difficult to be extracted by conventional endoscopic means. Bile duct drainage was established in all the patients without complications. Of the patients, 24 died with endoprosthesis in situ all from causes unrelated to biliar disease; 22 underwent a second and three patients a third attempt at stone extraction. The largest stone diameter was >12 mm in all patients. Results: In 11 of 25 patients (44%) the endoprosthesis allowed resolution of the problem of unextractable common bile duct stones. Four patients showed no existence of stent, and ERCP complete stone clearance from the CBD on programmized appointment after endoprosthesis insertion. Reduced size or fragmentation of stones was obtained in seven patients, and the stones could be removed endoscopically. The remaining 14 patients demonstrated no significant change in the size or fragmentation of their stones, and endoprostheses were replaced. Conclusions: These results suggest that endoscopic endoprosthesis for large or difficult CBD stones is an effective method to clear the duct in selected cases, as well as an important definitive treatment in high-risk patients.

Laparoscopic cholecystectomy (LC) is now the treatment of choice for gallstones, but there has been concern that bile leakage with LC is more frequent than after open cholecystectomy (OC). We have analyzed our experience of this complication with regard to both its incidence and management. From a consecutive series of 500 LC, in which both operative cholangiography and drainage of the gallbladder bed were routine, bile leakage was identified in ten patients (2%). There was no bile duct injury. Nine of the ten patients presented with bile in the drain within 24 h of operation and one patient presented 1 week after operation with a subphrenic collection. Of the ten patients, five settled spontaneously. Of the five remaining patients, two needed laparotomy-one for a subphrenic collection not responding to percutaneous drainage and one for biliary peritonitis. One patient was treated by relaparoscopy and suture of a duct of Luschka and one patient had successful percutaneous drainage of an infected collection; the fifth patient who presented with a late subphrenic collection of bile was shown at endoscopic retrograde cholangiopancreatography (ERCP) to have a cystic duct stump leak and was treated with an endoscopic stent. Bile leakage is seen more frequently after LC than OC for reasons that are currently unclear. We believe that the use of routine gallbladder bed drainage is justified for this reason alone. The majority of bile leaks settle either spontaneously or with minimally invasive intervention.

Fish bone bowel perforation has been shown as a major cause of
presentation in the emergency room, even though most dietary foreign bodies are passed unnoticed. This a case report of a couple of
patients who presented at the emergency room with acute abdominal pain. Both patients had no memory of recently swallowing any
fish bone. Case 1 showed moderate right upper quadrant tenderness and hepatomegaly, while case 2 had paraumbilical tenderness
and guarding. On CT imaging both patients demonstrated intraabdominal abscesses: in the liver for case 1, and intraperitoneal and
anterior abdominal wall for case 2. Linear hyperdense structure
of calcific density (HU 93-151) was seen in each intraabdominal
abscess collection, and an abutting adjacent bowel loop. These imaging findings were confirmed during surgical intervention: laparoscopic hepatic abscess drainage and laparotomy/anterior abdominal wall repair respectively for case 1 and case 2.

Background: Adenomatous hyperplasia (AH) is an uncommon benign lesion of the gallbladder (GB), predominantly seen in men. AH is commonly confused with malignant GB neoplasms in the setting of chronic cholecystitis and gallstones. There is a scarcity of published literature on AH, suggesting its rarity and the need for this case report. Case Presentation: A 24-year-old woman from Western Uganda presented with signs and symptoms consistent with extrahepatic biliary obstruction. Trans-abdominal ultrasound scan revealed cholecystomegaly (13.9 cm by 4.29 cm), thickened GB wall at 5.2 mm, with a poorly defined hypoechoic polypoid solid mass involving the fundal body of the GB. Explorative laparotomy with cholecystectomy and lymph node sampling was performed. Histopathological examination was consistent with adenomatous hyperplasia of the GB. The symptoms and laboratory values improved on follow-up in the clinic after laparotomy. Conclusion: Adenomatous hyperplasia may be misdiagnosed as a malignant GB neoplasm, especially in the setting of chronic cholecystitis and gallstones. If a correct histopathological diagnosis is made, no further diagnostic work-up is necessary following surgical interventions.

Background The ideal method for evaluation of the common bile duct (CBD) before or during cholecystectomy remains controversial. Magnetic resonance cholangiography (MRC) is a new, promising technique. A prospective evaluation is reported. Method Sixty-one patients (45 women) were studied by MRC. There were 29 patients with symptomatic gallstone disease and without clinical, biochemical or ultrasonographic evidence of CBD stones (group 1); 28 of them also underwent intraoperative cholangiography (IOC). In addition, there were 21 patients with symptomatic gallstone disease, with mild biochemical and ultrasonographic signs of CBD involvement (group 2), of whom 19 underwent IOC, and 11 patients with symptomatic CBD stones (group 3), nine of whom had preoperative endoscopic retrograde cholangiopancreatography (ERCP) following MRC. Results MRC showed that no patient in group 1 and three patients in group 2 had CBD stones. Three patients (one in group 1, two in group 2) did not undergo IOC because of technical or clinical problems. In group 3, ERCP confirmed the results of MRC in nine patients. Two patients underwent open surgery because of ultrasonographic, MRC and radiographic signs of pancreatic malignancy. Conclusion MRC could replace IOC and ERCP for identification of asymptomatic CBD stones. In symptomatic patients MRC combined with other non-invasive imaging techniques can direct the surgeon to appropriate management.

Recurrent acute pancreatitis is characterized by frequent episodes of inflammation in the pancreas. The most common causes are alcohol abuse and gallstones but approximately 30% of cases are defined as idiopathic because initial evaluation fails to detect the etiology. In these patients, extensive laboratory and imaging evaluations usually lead to the uncovering of an occult biliary duct stone or sphincter of Oddi dysfunction as the main reason for frequent pancreatitis. We report a 42-year-old female with a longstanding history of acute recurrent pancreatitis in the setting of pancreas divisum due to its rarity. We focus on appropriate investigations by application of specialized laboratory and radiological modalities because determining the etiology is a crucial step in patient management.

Background: If gallstones are not causing discomfort, there is usually no need to treat them. Many people with gallstones do not experience any symptoms for a long time. In addition, any treatment can have side effects, and operations are always associated with a certain level of risk. Gallbladder stones are treated differently than stones in the bile duct. If symptoms such as cramp-like pain (colic) occur, they can be relieved with medication. Such pain can only be prevented permanently by removing the gallbladder. An operation is also an option for people without symptoms but with very large gallstones - or with a porcelain gallbladder. The wall of the gallbladder is calcified and there is an increased risk of gallbladder cancer. Methods: This was an analytical cross-sectional study to spotlight the satisfaction levels of the Saudi Population towards the different treatment options for gallstones.  The study was carried out at universities, hospitals, and malls in KSA. Data were c...

Background: Gallstone disease is common worldwide and majority of patients undergo surgical management. Since the advent of laparoscopic cholecystectomy surgeons has become less interested in its aetiology. Infection is a major factor in the formation of gallstones. There are many infective complications reported of gallstones spilled during cholecystectomy. Presence of bacteria or its DNA by microscopy does not prove the infective potential of such stones. Thus culture of the nidus of the gallstone is the gold standard method to identify any potentially infective bacteria within and to predict the infective potential of gallstones.Methods: Cross sectional study done in seventy patients admitted for elective cholecystectomy for a period of 24 months from August 2016 to July 2018 in Department of Surgery, Regional Institute of Medical Sciences, Imphal, India.Results: Of the 70 stones cultured for bacteria, 52 (74.3%) were sterile and 18 (25.7%) were positive for bacteria, among which...

El gold estándar de la cirugía actual conlleva la búsqueda de los procedimientos mini invasivos, manteniendo o mejorando la efi ciencia sobre los tradicionales. En el tratamiento de la enfermedad litiásica biliar, se han desarrollado técnicas que complementan la colecistectomía laparoscópica para la extracción de cálculos del colédoco. Se sabe que entre el 10 al 18% de los pacientes con enfermedad litiásica vesicular presentan cálculos en el conducto biliar 1 . Para el manejo de la litiasis de la vía biliar, las alternativas son: la extracción de cálculos vía endoscópica con esfi nterotomía (CER), que puede realizarse en el tiempo pre, intra o post operatorio y la extracción de cálculos mediante cirugía abierta o laparoscópica, accediendo a la vía biliar principal por el conducto cístico o directamente por coledocotomía . En la actualidad, en muchos centros se considera la vía retrógrada endoscópica como la mejor alternativa para complementar los procedimientos laparoscópicos, y aunque la exploración laparoscópica de la vía biliar se ha desarrollado casi desde los inicios de la colecistectomía laparoscópica, esta técnica no se efectúa muy frecuentemente. En pacientes sometidos a colecistectomía lapa-*Recibido el 12 de Diciembre de 2009 y aceptado para publicación el 5 de Enero de 2010.

Open choledochostomy still represents an important step of biliary surgery, even during the era of laparoscopic surgery. Although its application has decreased with the widespread use of endoscopic retrograde cholangiopancreatography (ERCP) and papillotomy, still there are some patients in whom it is necessary to perform open choledochostomy and place a T-tube. The morbidity and mortality rates depend mainly on the presence or absence of an acute suppurative cholangitis, rather than the performance of the choledochostomy. In patients with mild cholangitis or those no cholangitis and less than 60 years of age, the mortality rate is lower than that observed after ERCP. This procedure is still an important technique for surgeons dedicated to biliary surgery, and therefore several technical aspects of common bile duct exploration are important to remember.

We describe the second reported case of three consecutive episodes of gallstone ileus and ask the question whether recurrent gallstone ileus justifies definitive surgery to the fistula itself or can be safely managed by repeated enterotomies.

Gall stone disease is a common health problem and carcinoma of gall bladder is the fifth commonest GI malignancy world wide. Gallstones afflict 10% to 20% of adult populations in developed countries. Gallstone disease is a common surgical problem requiring cholecystectomy. It is known to produce diverse histopathological changes in the gallbladder ranging from acute or chronic inflammation to metaplasia and even malignancies. The aim of the present study is to estimate various gallstone characteristics like morphological type, number, size and volume association with age and sex ratio. These parameters have been reviewed and analyzed in detail as a part of Ph.D thesis work of the second author under first author. Our objective is to find out the morphology of cholelithiasis.

Despite the ongoing evolution in the medical treatment of biliary pathology, the standard of treatment for gallstones remains cholecystectomy. There are no alternative treatments that have shown the same efficacy as surgery. Current alternative treatments have shown high recurrence and failure rates. Cholecystectomy remains the gold standard for management of gallstones. The surgical access of laparoscopic cholecystectomy accomplished by Mouret in 1987 allows for a reduction in operative trauma, hospital stay, postoperative pain and convalescence. These factors permit a faster return to normal activities. Today, laparoscopic cholecystectomy is performed in almost all medical centers around the world; however, the procedure is not free of complications. The objective of this study was to analyze our first 1000 cases of laparoscopic cholecystectomy, giving emphasis to the morbidity and mortality of the procedure.

Despite the ongoing evolution in the medical treatment of biliary pathology, the standard of treatment for gallstones remains cholecystectomy. There are no alternative treatments that have shown the same efficacy as surgery. Current alternative treatments have shown high recurrence and failure rates. Cholecystectomy remains the gold standard for management of gallstones. The surgical access of laparoscopic cholecystectomy accomplished by Mouret in 1987 allows for a reduction in operative trauma, hospital stay, postoperative pain and convalescence. These factors permit a faster return to normal activities. Today, laparoscopic cholecystectomy is performed in almost all medical centers around the world; however, the procedure is not free of complications. The objective of this study was to analyze our first 1000 cases of laparoscopic cholecystectomy, giving emphasis to the morbidity and mortality of the procedure.

Background: Between 05 to 20 percent of patients undergoing cholecystectomy for gallstones, have choledocholithiasis. Treatment of the common bile duct (CBD) stones can be conducted as open cholecystectomy and open CBD exploration or laparoscopic cholecystectomy plus laparoscopic CBD exploration (LC + LCBDE) versus pre- or post-cholecystectomy endoscopic retrograde cholangiopancreatography (ERCP) in two stages, usually combined with either sphincterotomy or sphincteroplasty (papillary dilatation) for CBD clearance. The merits and demerits of individual techniques are yet to be settled.Methods: We reviewed the outcome of patients operated at our centre after failed endoscopic clearance of CBD stones. Over a period of 03 years, total 2145 laparoscopic/open cholecystectomies were performed at our institute. In the same time period, 14 patients (06 males and 08 females) presented with choledocholithiasis after failed ERCP extraction (median age 59 years, range 29-62 years). All the pati...

Background  Decreased gallbladder smooth muscle (GBSM) contractility is a hallmark of cholesterol gallstone disease, but the interrelationship between lithogenicity, biliary stasis, and inflammation are poorly understood. We studied a mouse model of gallstone disease to evaluate the development of GBSM dysfunction relative to changes in bile composition and the onset of sterile cholecystitis.Methods  BALB/cJ mice were fed a lithogenic diet for up to 8 weeks, and tension generated by gallbladder muscle strips was measured. Smooth muscle Ca2+ transients were imaged in intact gallbladder.Key Results  Lipid composition of bile was altered lithogenically as early as 1 week, with increased hydrophobicity and cholesterol saturation indexes; however, inflammation was not detectable until the fourth week. Agonist‐induced contractility was reduced from weeks 2 through 8. GBSM normally exhibits rhythmic synchronized Ca2+ flashes, and their frequency is increased by carbachol (3 μm). After 1 we...

Scanning electron microscopy with or without conventional energy dispersive x-ray microanalysis is currently used to identify gallstone microstructure and inorganic composition. Organic calcium salts are among many biliary constituents thought to have a role in gallstone nidation and growth. However, current analytical techniques which identify these salts are destructive and compromise gallstone microstructural data. We have developed a new technique for gallstone analysis which provides simultaneous structural and compositional identification of calcium salts within gallstones. Backscattered electron imaging is used to localize calcium within cholesterol at minimum concentrations of 0.01%. Windowless energy dispersive x-ray microanalysis produces elemental spectra of gallstone calcium salts which are qualitatively and quantitatively different. These combined techniques provide simultaneous structural and compositional information obtained from intact gallstone cross-sections and h...