RAPID CHOLESTEROL NUCLEATION TIME AND CHOLESTEROL GALL STONE FORMATION AFTER SUBTOTAL OR TOTAL COLECTOMY IN HUMANS

Changes in biliary lipid composition, pH, ionised calcium, total and u nconjugated bilirubin, and cholesterol nucleation time of gall bladder bile samples were examined in six patients who had undergone subtotal or total colectomy between five months and seven years previously, an d values were compared with those in control patients with no gall sto nes. The colectomy group mainly comprised patients with ulcerative col itis and familial adenomatosis coli, in whom only a short length of th e terminal ileum (mean (SEM) 2.25 (0.57) cm) had been resected. The re construction procedures were ileoanal anastomosis in two patients, ter minal ileostomy in two, ileorectal anastomosis in one, and J shaped il eal pouch-anal anastomosis in one patient. The distributions of age, s ex, and relative body weight were similar in the two groups. The gall bladder bile was lithogenic in the post colectomy group-these patients had a significantly increased cholesterol saturation index (p<0.01) a nd rapid cholesterol nucleation time (p<0.05) compared with the contro l group. A significant increase and the molar percentage of cholestero l and a decrease in that of total bile acid associated with significan tly decreased secondary bile acids (p<0.05) were observed in the post colectomy group. Gall stones formed in two of six patients after colec tomy were cholesterol stones containing more than 80% cholesterol by d ry weight. Total and unconjugated bilirubin, pH, and ionised calcium v alues were similar in the two groups. The results indicate that after total or subtotal colectomy with composition of gall bladder bile incr eases the risk of cholesterol gall stone formation.