DOI: http://dx.doi.org/10.18203/2349-2902.isj20194064

Bacteriological study of nidus of gallstones

Christo Cyriac Thomas, Sreejith V., Rosna Mary Anto, Fleming Nagarajan, Debaleena Goswami, Nongmaithem Mackson Singh, S. Ranita Devi

Abstract


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 16 stones showed mono-microbial growth while 2 showed poly-microbial growth. Most commonly isolated organism was E. coli and Klebsiella followed by Pseudomonas, Enterococcus and Staph aureus.

Conclusions: Moynihan‘s aphorism “gall stone is a tomb erected in the memory of the organism within it”, suggest bacteria inside gallstone to be dead but this study proves that bacteria can be viable inside gallstone and its complete retrieval should be done in case of spillage which may help in avoiding complications. 


Keywords


Gallstone bacteriology, Stone culture, Nidus of gallstone

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References


Ahmad F, Islahi S, Hingora OM, Singh Y. Cholelithiasis: a clinical and microbiological analysis. Int J Sci Stud. 2014;2(4):40-5.

Nomura H, Kashiwagi S, Hayashi J. Prevalence of gallstone disease in a general population of Okinawa, Japan. Am J Epidemiol. 1988;128(3):598-605.

Sun H, Tang H, Jiang S, Zeng L, Chen EQ, Zhou TY, et al. Gender and metabolic differences of gallstone diseases. World J Gastroenterol. 2009;15(15):1886-91.

Unisa S, Jagannath P, Dhir V, Khandelwal C, Sarangi L, Roy TK. Population-based study to estimate prevalence and determine risk factors of gallbladder diseases in the rural gangetic basin of north India. HPB (Oxford). 2011;13(2):117-25.

Chen CH, Huang MH, Yang JC. Prevalence and risk factors of gallstone disease in an adult population of Taiwan: an epidemiological survey. J Gastroenterol Hepatol. 2006;21(11):1737-43.

Cotran SR, Kumar V, Robbins WB. Robbins pathologic basis of disease. 5th Edition. Philadelphia: W B Saunders; 1994.

Mendez SN, Zamora VD, Flores JA, Perez JA, Vasquez FF, Lezama MJ, et al. Gallstones are associated with carotid atherosclerosis. Liver Int. 2008;28(3):402-6.

Sanchez CJ, Aguilar M, Arambula ME, Romero NJ, Granados J, Sicairos ML, et al. ApoB-100, ApoE and CYP7A1 gene polymorphisms in Mexican patients with cholesterol gallstone disease. World J Gastroenterol. 2010;16(37):4685-90.

Temel RE, Brown JM. A new framework for reverse cholesterol transport: non-biliary contributions to reverse cholesterol transport. World J Gastroenterol. 2010;16(47):5946-52.

Reshetnyak V. Concept of the pathogenesis and treatment of cholelithiasis. World J Hepatol. 2012;4(2):18-34.

Hazrah P, Oahn KT, Tewari M, Pandey AK, Kumar K, Mohapatra TM, et al. The frequency of live bacteria in gallstones. HPB (Oxford). 2004;6(1):28-32.

Swidsinski A, Khilkin M, Pahlig H, Swidsinki S, Priem F. Time dependent changes in the concentration and type of bacterial sequences found in cholesterol gallstones. Hepatology. 1998;27(3):662-5.

Stewart L, Griffiss JM, Jarvis GA, Way LW. Bacteria entombed in the centre of cholesterol gallstones induce fewer infectious manifestations than bacteria in the matrix of pigment stones. J Gastrointest Surg. 2007;11(10):1298-308.

Hassan SM, Baloch S, Memon F, Ali J, Quraishy SM. Frequency and type of organisms in gallstone culture. J Dow Uni Health Sci. 2015;9(1):89-93.

Lee JW, Lee DH, Lee JI, Jeong S, Kwon KS, Kim HG, et al. Identification of helicobacter pylori in gallstone, bile and other hepatobiliary tissues of patients with cholecystitis. Gut Liver. 2010;4(1):60-7.

Stewart L, Smith AL, Pellegrini CA, Motson RW, Way LM. Pigment gallstones form as a composite of bacterial microcolonies and pigment solids. Ann Surg. 1987;206(3):242-50.

Leung JW, Sung JY, Costerton JW. Bacteriological and electron microscopy examination of brown pigment stones. J Clin Microbiol. 1989;27(5):915-21

Leung JW, Liu YL, Lau GC, Chan RC, Lai AC, Ling TK, et al. Bacteriologic analysis of bile and brown pigment stones in patients with acute cholangitis. Gastrointest Endosc. 2001;54(3):340-5.

Kim IS, Myung SJ, Lee SS, Lee SK, Kim MH. Classification and nomenclature of gallstones revisited. Yonsei Med J. 2003;44(4):561-70.

Jayanthi V. Pattern of gall stone disease in Madras city south India, a hospital based survey. J Assoc Physicians India. 1996;44(7):461-4.

Ashok M, Rautray TR, Nayak PK. Energy dispersive X-ray fluorescence analysis of gallstones. J Radioanal Nucl Ch. 2003;257(8):333-5.

Amin AM, Ananthakrishnan N, Nambinarayanan TK. Composition of gallstones and sequential events in biliary lithogenesis: is it different in south India compared to north. J Assoc Physicians India. 2000;48(9):885-90.

Gupta A, Ramteke S, Kanwar K, Soni P. Study of morphological spectrum of gallstone and bacteriology of bile in cholelithiasis. Int Surg J. 2017;4(1):177-9.

Aird I. A companion in surgical studies. 2nd Edition. London: Churchill Livingstone; 1958.