Inflammatory exudate and debris, and bacteria may cause stones by providing suitable nidi for stone formation.
The inflammatory response may be a chemical reaction to abnormalities of bile composition or may be a primary cholecystosis.
Bacteria may enter the gall bladder by reflux from the duodenum or via the blood stream. Improper gallbladder emptying enables the bacteria to remain and accumulate. The lamination of the stones probably reflects episodic periods of bacterial ingress and precipitation.
Organisms may be recovered from 25% of cholecystectomy specimens.
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