Passage of stone fragments from the gallbladders of dogs.

The destruction of gallstones by shock waves leads to a considerable amount of stone fragments in the gallbladder. To test the ability of the stones fragments to leave the gallbladder, kidney stone fragments of 2 or 4 millimeters maximal diameter were implanted into the gallbladders of 16 dogs and passage was observed for five weeks. Independent of stone size, about 35 per cent of the fragments remained in the gallbladder. Transient elevations of enzymes of the liver or pancreas occurred significantly less often with 2 millimeter fragments and were less pronounced. Gross pathologic changes of the papilla of Vater, or dilation of the bile duct were observed with 4 millimeter fragments but not with those that were 2 millimeters. The results of this study suggest that the maximal fragment size after destruction of gallstones should be as small as possible, that is, in the range of 2 millimeters.