Pathogenesis of Gallstones Developed Following Gastrectomy with Special Reference to Classification of Stones and Bile Analysis

Ritsuro Usui, Hideo Ise, Yoshinobu Takahashi, Osamu Kitayama, Akihito Moriyasu, Shoichi Satoh, Haruyuki Inoue, Noriyoshi Suzuki, Seiki Matsuno

First Department of Surgery, Tohoku University School of Medicine

Fifty-three patients who had received gastrectomies were studied by gallstone classificatin, bile culture and bile analysis to determine the factors affecting gallstone formation after gastrectomy. Black stones were found most frequently (43.4%), and the results of bile analysis showed that the concentration of total bile acid and phospholipid decreased in 9 patients with black stones after gastrectomy compared with those of 15 black stone paients without prior gastrectomy, while the ionized calcium concentration increased in those post-gastrecrmy patients. The excess of ionized calcium in the bile of these patients was thought to be the result of the decreased concentration of bile acid and phospholipid, and it is suggested that the increased level of ionized calcium in bile promotes black stone formation after gastrectomy. In patients who underwent gastric resection with duodenal diversion such as the Billroth-II method, black stones were found in 43.6%, calcium bilirubinate stones were frequent (33.3%) and positive bile culture was at high rate (71.0%). It is suggested that, after such reconstruction procedures, absence of gastric acid in the duodenum induces a change in the bacterial flora in the excluded loop resulting in bile duct infection and may eventually induce calcium bilirubinate stone formation.

Key words
gallstones after gastrectomy, calcium in bile, bile acid, phospholipid in bile

Reprint requests
Ritsuro Usui First Department of Surgery, Tohoku University School of Medicine
l-1 Seiryo-machi, Aoba-ku, Sendai, 980 JAPAN

Accepted
June 13, 1990

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