J.Jpn. Surg. Soc.. 83(9): 817-819, 1982

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Report on the annual meeting

ON NOMENCLATURE OF PIGMENT GALLSTONES

Gallstones of pigment line are to be classified into two types. One is a black gallstone or a conventional pure pigment stone formed in the gallbladder without any biliary infection, especially under conditions of an increase in the bilirubin content of the blood serum. The peculiarity of this stone is a black color of its external and cut surface appearance. According to our study, black appearing substances which is main component of these stones were considered to be mostly of polymerized bilirubin and its derivatives and their complex compounds with inorganic electrolytes.
The other is a gallstone formed by aggregation of pigment particles induced by biliary infection. Chemical and physico-chemical analyses revealed that main constituent of these particles are a compound of calcium bilirubinate. In a condition of bile infection, especially with E. coli, bilirubin glucuronide is hydrolyzed by the β -glucuronidase activity of bacterial origin. Calcium in bile can combine with liberated free bilirubin at its carboxyl radical forming spherical particles. Therefore, these infection-mediated gallstones should be called as a calcium bilirubinate stone.

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