Gallstones and common bile duct stones—surgical and non-surgical approaches

In western populations the consumption of a diet which is high in cholesterol and fat leads to the supersaturation of bile, with resultant precipitation and crystal growth ( Fig. 41.1 ). Pure cholesterol stones are often solitary or exist as clusters of “mulberries” ( 9 ). Bile pigment stone are multiple, irregular, small, black, and fragile. They are seen in patients with chronic hemolysis (hereditary spherocytosis and sickle cell disease) and cirrhosis, where there is an increase in bilirubin ( 10 ). Mixed stones, composed of varying proportions of the above ingredients, are usually multiple.