The results of this study suggest that infection with beta-glucuronidase active bacteria is the initial eventin the nucleation of primary bile duct stones (PBDS).PBDS from five patients were morphologically fragile and “earthy” with alternating light and darkbrown pigment layers with no evidence of a distinct central nucleus that may have been reminiscent of adifferent structure. Chemically, calcium bilirubinate and calcium palmitate were prominent throughouttheir structure. All bile duct biles had a positive culture and were always associated with at least onebacterial species which was beta-glucuronidase active. Moreover, fragments of PBDS nuclear areas hadpositive cultures that were comparable with those present in their individual bile duct bile. Microscopicexamination of bile showed abundant precipitation of calcium bilirubinate granules in all samples.Thus, bile duct bile infection with beta-glucuronidase active bacteria (e.g.E. coli, C. perfringens)appears to be a key factor in PBDS pathogenesis, having a precursor role, rather than being aconsequence. Bile stasis is likely to be a co-factor which must have a supportive role in subsequent stonegrowth.
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