THE INCIDENCE OF LIVE BACTERIA IN BILE, GALLBLADDER INNER WALL AND GALLSTONES IN GALLSTONE DISEASE- A SEARCH
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2017, Vol 6, Issue 44
Abstract
BACKGROUND Gallstone disease and associated cholecystectomy has taken enormous portion of all surgical procedures in the world, as it is the most frequent surgical procedure practiced in any part of the world. The myth of fat, fertile, female of forty has long been busted as also the story of “Typhoid Mary.” As gallstones are now seen in all age groups, in both sexes and in all corners of the globe, most frequently asked question confronted by the surgeons in the clinic from the patients is how these stones occur? Various theories of stone formation have been postulated, but the role of bacteria in gallstone formation is still mysterious. In this study, we are trying to find out the incidence of live bacteria in bile, gallbladder inner wall and gallstones in gallstone disease. MATERIALS AND METHODS This is a short-term, prospective, observational study. Conveniently selected 50 patients with Gallstone disease who underwent cholecystectomy in our surgical unit of IPGME and R and SSKM Hospital during May 2015 to October 2016 were studied for existence of infectious foci in the form of live bacterial pathogen as cultured from bile, gallbladder inner wall and gallstone. RESULTS Majority of the patients were female [88%] with mean age of 40.5 years. Most of the patients had cholesterol stones (35 cases), followed by pigment stones (10 cases) and mixed stones (5 cases) in the gallbladder. Bile culture was positive in 6 patients, gallbladder inner wall culture was positive in 7 patients and gallstones culture was positive in 4 patients rendering 12 patients having culture positive in either source. E. coli and Klebsiella spp. (in 3 patients each) were the predominant organisms seen in these cultures. Out of 35 patients with cholesterol stones, 3 patients had positive growth; and out of 10 patients with pigment type of stones, 4 patients had positive growth; and all 5 patients with mixed type of stones showed positive bacterial growth in at least one sample. The mixed stones had statistically higher incidence of culture positivity than cholesterol and pigment stones (χ2= 21.8, p < 0.001). Males had significantly higher association with live bacteria than female (χ2= 13.16, p= 0.002). HPE report of specimen of gallbladder showed chronic cholecystitis in all 50 patients. CONCLUSION 12 patients being positive for bacterial infection is significantly high as in general consensus bile and gallbladder, both are sterile. Higher incidence of positive culture was found in patients with mixed stones than cholesterol and pigment stones, though overall incidence of cholesterol stone was maximal. Type of stone is single deterministic factor in the incidence of bacterial culture positivity. Since different gram negative bacterial organisms are more co-existent in gallstones, there might be a new consensus required for antibacterial protocol in the management of gall stone disease in a given area.
Authors and Affiliations
Partha Sarathi Mandal, Kumar Dheeraj, Saurabh Das, Probhas Kumar Sarkatr, Nupur Pal
Keywords
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- EP ID EP215561
- DOI 10.14260/Jemds/2017/745
- Views 92
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