We used infrared absorption spectroscopy to clarify the characteristics of black pigment in gallstones, which is insoluble and amorphous, and is considered to be a polymer of bilirubin or calcium bilirubinate with tetrapyrrol units. Black stones contain several metallic elemental components that exist as complex compounds with bilirubin. Chemical analysis of gallbladder bile indicates that the mechanism by which unconjugated bilirubin is precipitated depends on the pH level or on bile acid components. Black pigment is formed by the bridging action of mucin, forming complexes with metal ions in the bile. Hemolytic jaundice, liver cirrhosis, and cardiac valve replacement have been implicated in the etiology of black stone formation. In hemolytic jaundice and cardiac valve replacement, overproduction of bilirubin, due to hemolysis, is responsible for black stone formation, while in liver cirrhosis, a high concentration of ionized calcium and increased pH levels are the main factors in such stone formation.
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First Department of Surgery, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, 980-77, Sendai, Japan
Hideo Ise, Akihito Moriyasu, Noriyoshi Suzuki, Takeshi Naitoh & Seiki Matsuno
Ise, H., Moriyasu, A., Suzuki, N. et al. Pathogenesis of black stones. J Hep Bil Pancr Surg 4, 412–416 (1997). https://doi.org/10.1007/BF02488974
Received: 19 December 1996
Accepted: 27 February 1997
Issue Date: December 1997
DOI: https://doi.org/10.1007/BF02488974
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