[Failed dissolution of a gallstone by methyl tert-butyl ether: importance of predicting gallstone chemical...

In December 1986 we attempted direct chemical litholysis using methyl-tertiary-butyl-ether (MTBE) in a sixty-year-old man with severe ischemic heart disease who had suffered frequent episodes of biliary colic due to a radiolucent gallstone. MTBE was infused for a total of 17 hrs over a period of 5 days; however the gallstone diameter remained unchanged. The patient was subsequently cholecystomized and chemical analysis revealed that the gallstone was a pigment stone. The need for accurate prediction of gallstone composition before beginning an invasive, such as MTBE infusion, is emphasized.