Classification, Composition and Structure of Gallstones. Relevance of these Parameters for Clinical Presentation and Treatment

  • Francesco Cotta


Gallstones should no longer be considered as a unique entity, but as a heterogenous disease [1, 2, 3, 4, 5, 6, 7, 8], which includes at least three different subgroups: cholesterol stones, mixed stones with cholesterol as the main component (for which cholesterol supersaturation of the bile may be of importance) and pigment stones, which are distinguished as black or brown pigment. Supersaturation of the bile with cholesterol is not of prime importance for the formation of pigment stones. In addition to these three main types of gallstone, there are also combination stones and composite gallstones. The former include stones with a central nidus of one type (cholesterol or black pigment) and an outer portion of another type (brown or calcified periphery); the latter occur when pure cholesterol stones are found within the same gallbladder or bile duct together with pure pigment stones, i.e. there are at least two different stone populations in the same subject (Table 4.1).


Cystic Duct Common Bile Duct Stone Endoscopic Sphincterotomy Common Duct Cholesterol Gallstone 
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© Springer-Verlag Italia 2008

Authors and Affiliations

  • Francesco Cotta
    • 1
  1. 1.Department of Surgery Interuniversity Center for Research in Hepatobiliary DiseaseUniversity of SienaSienaItaly

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