Histological Facets of Cholelithiasis in Iraqi Patients Facing Cholecystectomy: Possible Role of Infection

Background: Cholelithiasis is a frequently encountered surgical problem that requires intervention. Infection may lead to deposition of bile and gallstones could enhance the bacterial growth. Objectives: Is to identify and characterize the infection in the gallbladder in cases with cholelithiasis, and to identify types of pathogens if present using both of the microbiological and histopathological assessments. Materials and methods: Cross-sectional observational study performed on 43 patients who underwent an elective cholecystectomy (laparoscopically) and age group ranging from 20-78 year for a period of 2 months from January1 to March 1, 2025, at Al-jumhori Teaching hospital in western side of Mosul Province, Iraq. All gallbladders were assessed microbiologically and histopathologically. Each gallbladder was incised and examined under light microscope and staining Microscopic examination was done to define the type of histological alterations. The cultures were obtained from several parts of gallbladder. Results: Females to males ratio equal to 5.1:1. Mean age was 56.5 ±1.2 year. Thirty eight out of 43 cases (88.3%) manifested at least one positive culture sample while the remaining 5(11.7%) were negative in all samples. The commonest microorganisms identified were Escherichia coli which was noticed in 13(33.4%) out of 39 cases followed by Enterobacter aerogenes. The cholecystitic changes were noticed in one (25%) out of 4 acalculus gall bladder using haematoxylin and eosin. Various histological abnormalities were shown in 42(95.5%) stones containing gallbladders which was significantly higher than that in acalculus gall bladder (P<0.05). Conclusions: Escherichia coli were the most frequent pathogen. There is a need for more than single antibacterial agent or a broad-spectrum therapy for these cases. Advanced techniques and modern diagnostic tools are crucial to characterized bacterial strain at our locality and to identify role of bacteria in the genesis of cholelithiasis. Rokitansky-Aschoff Sinuses were the most frequent lesions and this support the hypothesis that this lesion may have a role in the pathogenesis of gallstones formation.