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Gallstones at autopsy and cholecystectomy: a comparative study
1University of Melbourne, Department of Surgery, Repatriation General Hospital, Victoria, Australia.
The Australian and New Zealand Journal of Surgery
|July 1, 1988
Summary
Biliary disease, including gallstones and sludge, affects 36.5% of autopsies, with females twice as likely as males. Cholesterol gallstones are more prevalent in cholecystectomy patients, particularly women, and biliary sludge may precede gallstone formation.
Area of Science:
- Gastroenterology
- Pathology
- Epidemiology
Background:
- Biliary disease prevalence varies geographically and by demographic factors.
- Gallstones and biliary sludge are common conditions affecting the gallbladder and bile ducts.
- Understanding the epidemiology of biliary disease is crucial for public health initiatives.
Purpose of the Study:
- To determine the prevalence of biliary disease, including gallstones and biliary sludge, in a post-mortem Australian population.
- To investigate the association between sex and gallstone type (cholesterol vs. pigment) in both autopsy and cholecystectomy cohorts.
- To explore the potential role of biliary sludge as a precursor to gallstones.
Main Methods:
- Retrospective analysis of 613 post-mortem examinations.
- Examination of gallstones and biliary sludge from 310 cholecystectomy patients.
- Statistical analysis, including chi-squared tests, to assess associations between variables.
Main Results:
- Biliary disease prevalence at autopsy was 36.5%, higher than previously reported in Australia.
- Asymptomatic gallstones were found in 18.9% of autopsies, with 5.7% having biliary sludge and 11.9% a history of cholecystectomy.
- Cholesterol gallstones were more common than pigment gallstones in cholecystectomy patients, with a significant sex-based association. The female to male ratio for biliary disease was approximately 2:1.
- Pigmented biliary disease was significantly more prevalent at autopsy than in cholecystectomy patients.
- Biliary sludge analysis suggests it may be a precursor to gallstone formation.
Conclusions:
- Biliary disease is highly prevalent in the Australian population, with a notable female predilection.
- Cholesterol gallstones show a different prevalence pattern in symptomatic (cholecystectomy) versus asymptomatic (autopsy) populations, with a strong sex association in the former.
- Biliary sludge represents a significant finding at autopsy and may be a critical precursor in gallstone pathogenesis.