This looks like multiple tiny stones and would explain the pancreatitis and the
inability of conventional ultrasound and MRCP to detect them.
The gallbladder does not normally contain solid material.
Sludge and tiny gall stones or mircrolithiasis are invisible on
conventional ultra-sound and MRCP. Endoscopic ultra sound may show the small
stones or sludge but there is a low risk of perforation associated with
passage of the instrument. An exact definition of microlithiasis is difficult.
It can be used to indicate small stones such as this that are found at surgery
which were not seen on conventional ultra-sound. Some would use the term
microlithiasis to indicate even smaller stones that are invisible to the
unaided eye.
Enterobius vermicularis has not been found in the biliary tree. It usually
causes itchy bottoms and sometimes anaemia or appendicitis. Larger worms such
as ascaris have been found in the biliary tree.
A porcelein gallbladder is a calcified gallbladder that is seen on
radiological imageing. There is an association with chronic inflammation and a
marked increased risk of gallbladder cancer.
The majority of patients with so called ideopathic pancreatitis in fact
have microlitiasis that has not been detected with conventional imaging. If
other causes of pancreatitis are not found on investigation then
cholecystectomy should be considered.
It is wise to perform a peroperative cholangiogram at the time of
cholecystectomy in this circumstance. It offers an excellent image of the
biliary tree with little risk.
