GALLBLADDER STONE FRAGMENTS IN FECES AFTER BILIARY EXTRACORPOREAL SHOCK-WAVE LITHOTRIPSY

All stools passed on the first 3 days after extracorporeal shock-wave lithotripsy of gallbladder stones in 21 patients were collected and examined for the presence of stone fragments. A total of 555 fragments varying in number per patient (4-69) and in size (maximum diameters from 0.5-8.0 mm) were recovered by sieving aqueous suspensions of the feces. All 482 fragments <-3.0 mm left the biliary tract without any clinical symptoms, as did the three largest fragments with maximum diameters of 7.0-8.0 mm and almost all of the 70 fragments measuring 3.5-5.0 mm. During the observation period, four episodes of biliary complaints were recorded in three patients in whom fragments with maximum diameters of 3.5-5.0 mm were found. The only chemical abnormality was a temporary elevation of lipase activity to twice the normal range in 1 case. All fragments were identified as gallbladder stones by infrared spectroscopy on the basis of their (varyingly high) cholesterol content. By macroscopic criteria, most of the fragments were from mixed stones; therefore, provided there is a functioning gallbladder and sufficiently fine fragmentation, successful extracorporeal shock-wave lithotripsy does not seem to be limited to pure cholesterol stones. © 1990.