Bile Pigment Gallstones Treatment,Causes & Symptoms

Bile Pigment Gallstones – How to get rid of them.

Pigment stones are a common type of gallstones that are formed when there is excess quantity of bilirubin in bile. The hemoglobin in the old blood cells that are destroyed is converted into a chemical called bilirubin. This bilirubin is modified by the liver and is passed out with bile. There are two types of Pigment gallstones.

Black pigment gallstones: When excess bilirubin in the bile combines with other constituents of bile like calcium it forms a pigment which is poorly soluble in bile. This pigment sticks together to form particles and which grow into stones. These are called Black pigment gallstones as they are black and hard.

Brown Pigment gallstones: When there is reduced contraction or an obstruction in the biliary tract for the flow of bile, there is a chance for the bacteria to ascend from the duodenum to the gallbladder and alter the bilirubin which in turn combines with calcium to form pigment. This pigment is not easily soluble in bile and hence form particles which grow into stones. These are brown in colour and softer than black pigment gallstones.

Composition, Color and Consistency

  • The changes in color may be due to the amount of calcium salts, like calcium bilirubinate, and cholesterol which also affects the consistency. Mucin glycoprotein is the main compound that cements the stone.
  • The cholesterol is high in brown stones compared to black stones.
  • The concentration of bilirubin is high in black stones compared to brown stones.
  • Brown gallstones are softer and more greasy.
  • Black stones are firmer but crumble easily.

Size and Quantity

  • Pigments stones are smaller than cholesterol stones and are usually smaller than 1.5 centimters.
  • A single brown stone may occur more likely while several black stones may be found in the gallbladder.


  • Black pigment stones are usually found in the gallbladder.
  • Brown pigment stones are more frequently seen in the bile ducts.


  • Most black pigment stones are radiopaque and can be detected through an x-ray.
  • Brown pigment stones are radiolucent and may not be detected through an x-ray.

Causes of Bile Pigment Gallstones:

The main causes for the formation of Bile pigment gallstones are

  • Hemolytic Anemia which characterised by the deficiency of red blood cells because of their destruction.
  • Escherichia Coli Infection which passes the bacteria from the duodenum to the gallbladder which inturn alters the bilirubin.
  • Sickle Cell Anemia is a genetic disease which causes deformation of red blood cells which can be broken and produce large amounts of bilirubin which accumulates in the gallbladder.
  • Roundworm Infection which results in the build up of bile and the dead worms help in the formation of pigment stones.
  • Liver Cirrhosis results in producing excess amounts of bilirubin and which leads to the formation of pigment stones.

Black pigment gallstones are formed usually due to hemolytic anemia and brown pigment gallstones are formed due to an infection.

Symptoms of Bile Pigment Gallstones.

The common symptoms that can be seen if there are bile pigment gallstones are as follows:

  • Abdominal pain
  • Abdominal swelling, distension or bloating
  • Abdominal symptoms that occur within minutes after a meal
  • Abdominal tenderness
  • Clay-colored stools
  • Fever and chills
  • Loss of appetite
  • Nausea with or without vomiting
  • Pain that radiates from the abdomen to the right shoulder or back
  • Sweating
  • Yellowing of the skin and whites of the eyes (jaundice)

These symptoms may appear daily or in some cases just in a while and sometimes may become severe. If you find any such symptoms you need to consult your doctor immediately.

Bile Pigment Gallstones Treatment:

The treatment for gallstones can be done in two ways. Surgical treatment and Non-surgical treatment.

Surgical treatment:

Laproscopic surgery: In this surgery number of tiny incisions are made in the abdomen and medical instruments along with a camera are sent and the gallbladder is removed by monitoring through a computer. This is simple when compared to the traditional open surgery and the patient can resume to work in 3 to 5 days.

Open Surgery: In this method an incision of 5 inch to 8 inch is made and the gallbladder is removed. This surgery is called Cholecystectomy. This surgery is not opted now and is usually done if there is a gallbladder infection or some other complications which make laproscopy unsuitable.

Non-surgical treatment:

This treatment is of three types. Oral Dissolution Therapy, Contact Dissolution Therapy, Extracorporeal Shock Wave Lithotripsy. These treatments best suit for cholesterol stones.

Not only these treatments there are natural treatments also which involve home remedies and help in the dissolution of the gallstones without any other treatments