Gallbladder stones are a prevalent condition globally, often detected through various diagnostic methods like ultrasonography and liver biochemistry. Laparoscopic cholecystectomy is the standard treatment, but innovative procedures like endoscopic gallbladder-preserving cholecystolithotomy have emerged to preserve gallbladder function while removing stones.
Intriguingly, during rigid choledochoscopic gallbladder-preserving cholecystolithotomy, some patients with gallbladder stones were found to have stones embedded within the gallbladder wall, termed intramural stones (IS). These IS exhibit unique characteristics such as stone shadows and yellow floating bands within the gallbladder wall, distinct from regular intraluminal stones.
A retrospective study analyzed 323 patients with gallbladder stones, revealing that IS were present in 24.1% of cases. These patients showed a higher prevalence of Clonorchis sinensis (C. sinensis) infection and elevated serum cholesterol levels. Logistic regression analysis identified C. sinensis infection and elevated Apo-B levels as independent risk factors for IS in patients with gallbladder stones.
C. sinensis infection, a zoonotic disease common in Asia, was significantly associated with IS formation, with eggs often encapsulated within IS. Moreover, elevated Apo-B levels impacted lipid metabolism and were linked to IS development. These findings shed light on the complex interplay of factors contributing to the formation of IS in patients with gallbladder stones.
The study also compared the composition of IS and intraluminal stones in the same patients, revealing a high concordance rate. Patients with IS did not show a higher recurrence rate post-surgery, indicating that IS removal during cholecystolithotomy effectively managed stone recurrence.
Overall, the study underscores the importance of considering IS, C. sinensis infection, and lipid metabolism changes in patients with gallbladder stones undergoing surgical interventions. By understanding the unique features and risk factors associated with IS, clinicians can enhance diagnostic and treatment strategies for better patient outcomes.
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