Pigment Sludge and Stone Formation in the Acutely Ligated Dog Gallbladder (original) (raw)
We studied the effects of stasis of gallbladder bile in a dog model. Three days after cystic duct ligation, all gallbladders contained sludge, and the mucosa was covered by densely adherent mucus with solid particles 1-4 mm in diameter (gravel). Thirty percent of the animals developed stones (>4 mm), which appeared grossly like human pigment stones and microscopically like condensed biliary sludge. Centrifugation of bile yielded colorless pellets (3.B ± 3.2 mg/ml) at day a and pigmented pellets (33.1 ± 11.0 mg/ml) at day 3 (p < 0.05). Pellets contained 73 ± B% mucin by weight. Dissolved mucin in supernatant bile increased from 7.46 ± 1.19 mg/ml (day 0) to 27.36 ± 3.05 mg/ml (day 3) (p < 0.001), while bilirubin concentration decreased from 127 ± 12 mg/dl (day 0) to 71 ± 16 mg/dl (day 3) (p < 0.001). Cholesterol concentration increased but did not reach saturation, while the concentration of bile salt and phospholipid did not change. Mucin-bilirubin complexes formed and remained suspended as sludge initially. As bile mucin content increased , sludge particles coalesced , precipitated, and eventually formed gravel and stones. We suspect that stone formation in this setting occurs because of sequestration of biliary lipids by mucin. Biliary stasis has been shown to induce pigment stone formation in animals (1,2) and in patients with biliary stricture (3). Gallbladder stasis may be a factor in cholesterol gallstone formation after vagotomy (4). We have previously reported that gallbladder
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Journal of Gastroenterology and Hepatology, 2000
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