Tiny cystine stones in the gallbladder of a patient with cholecystolithiasis complicating acute cholecystitis: a case report

Cholecystolithiasis, or gallbladder stone is a common and frequently encountered disease worldwide [1-4]. Gallbladder stones can be divided into four groups according to their location: intracavitary, cystic duct, intramural, and mucosal stones (small stones adhering to the mucosa) [5]. Based on their main component, gallbladder stones are divided into cholesterol stones, bile pigment stones, mixed stones, and other types [6-9] (including calcium carbonate stones, calcium phosphate stones, fatty acid stones, and cystine stones); this classification is mainly based on the infrared spectrum of the stones. Compared with other types of stones, cystine stones are rare in the gallbladder, although they are common in the urinary system. We report a patient with cystine gallstones.A 38-year-old woman with a 3-year history of cholecystolithiasis was examined at a local hospital and referred to our hospital for endoscopic gallstone removal without gallbladder excision. When she was hospitalized at our hospital, the acute right upper abdominal pain had persisted for two hours.On physical examination, no signs of jaundice were seen in the skin or sclera. The patient's abdomen was soft, with no sign of lumps, with tenderness other than rebound tenderness in the gallbladder area. Murphy's sign was positive. Ultrasonography revealed several movable masses of 7 × 10 mm and 7 × 9 mm in size, which were strongly echogenic, with acoustic shadowing in the body of the gallbladder; an immovable strongly echogenic mass of 7 × 10 mm with acoustic shadowing in the neck of gallbladder and cystic duct; and poor sound penetration and a dense, low-light spot in the dark space of the bile. There was no thickening of the gallbladder wall. The gallbladder emptying index was 30%. No obvious abnormalities were seen in the liver, spleen or pancreas.The patient was diagnosed as having cholecystolithiasis complicating acute cholecystitis and incomplete biliary-tract obstruction. The patient had been gi