Dear Label_Name,

Greetings! I hope you are well.

I am writing on behalf of an international publishing house, Science and Education Publishing, USA (http://www.sciepub.com).

Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
American Journal of Public Health Research
American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
American Journal of Zoological Research
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Label_Title

Dear Label_Name,

Greetings! I hope you are well.

I am writing on behalf of an international publishing house, Science and Education Publishing, USA (http://www.sciepub.com).

Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
American Journal of Public Health Research
American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
American Journal of Zoological Research
Journal of Biomedical Engineering and Technology
American Journal of Microbiological Research
Biomedical Science and Engineering

We are pleased to announce that submissions are now being accepted for peer review for all the journals across all our subject areas in SciEP.

Please submit your manuscript via our online submission system:
http://www.sciepub.com/author/signin

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I am looking forward to hearing from you.

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David Rain
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Gas in Gallstones

Youichi Yanagawa*, Raiki Tokutsu, Chihiro Maekawa, Noriko Tanaka, Kousuke Natsume

Acute Critical Care Medicine, Juntendo Shizuoka Hospital, Izunokuni City, Shizuoka Prefecture, Japan

Abstract: A 41-year-old man presented to our hospital with abdominal pain, and a CT scan revealed findings of adhesive ileus and an incidental gas-containing gallstone. Because gas-containing gallstones are uncommon, we presented a literature hypothesis of their pathogenesis.

Keywords: gas-containing gallstone, computed tomography: mechanism

Received May 16, 2025; Revised June 18, 2025; Accepted June 26, 2025

Citation: Youichi Yanagawa, Raiki Tokutsu, Chihiro Maekawa, Noriko Tanaka, Kousuke Natsume, Gas in Gallstones. American Journal of Medical Case Reports, 13 (5). 29-30. January 2025. doi:10.12691/ajmcr-13-5-1

1. Introduction

Gallstones are hardened deposits of cholesterol, bilirubin, and bile in the gallbladder or bile ducts. Although often asymptomatic, they can cause pain, nausea, vomiting, and complications such as cholangitis or pancreatitis, especially after fatty meals. They form when bile components precipitate out, sometimes trapping gas. Unlike gas from emphysematous cholecystitis, gas in gallstones is usually not harmful. [1,2,3,4] This report showed gas in gallstones 8 years after laparotomy.

2. Case Report

A 41-year-old man, who had undergone an enterotomy for small intestinal injury due to a traffic accident 8 years earlier, became aware of abdominal pain in the morning, which gradually worsened, and in the afternoon he started vomiting with oral intake. He came to our hospital alone. At the time of admission, his consciousness was clear, blood pressure was 128/93 mmHg, respiratory rate was 15 breaths/min, SpO₂ was 98%, and pulse was 72 beats/min. Ultrasound showed dilatation of the small bowel and back and forth movement of bowel fluid. Contrast-enhanced CT of the abdomen showed dilatation of the small bowel and formation of a fluid surface, but the mechanism of obstruction was unclear. Secondary findings included a large number of internal low-density gallstones with air and CT values (Figure 1). The patient was hospitalized for conservative management of postoperative adhesive bowel obstruction. The patient's symptoms improved with conservative treatment and he was discharged on day 7.

Several gallstones were found in the gallbladder with low absorption area in the center and oval-shaped high absorption area in the surrounding area. The CT value of the low-absorption area within the gallstones was ROI -32768, the same CT value as the surrounding air, and was determined to be gas.

Figure 1. Abdominal computed tomographic image (CT)

3. Discussion

In the present study, a 41-year-old man presented to our hospital with abdominal pain and a CT scan revealed findings of a rare incidental gas-containing gallstone in addition to adhesive ileus.

Huerta et al performed an institutional review of all patients with gaseous gallstones in the gallbladder over a 16-year period. [2] They identified 5 patients with gaseous gallstones in 1,252 consecutive cholecystectomies; 4 of these had cholecystitis and 1 was an incidental finding.They also reviewed the 30 manuscripts documenting 54 unique patients with gas-containing biliary stones. None of them had subsequent pathology related to gas in the stones other than that caused by the gallstones (i.e., biliary colic and cholecystitis). They concluded that gaseous gallstones are uncommon. Gas-containing gallstones should not be interpreted as free gas within the gallbladder or within an abscess, similar to our asymptomatic case. [2,4]

Regarding the gas composition and mechanisms of formation of gas-containing gallstones, the gas was less than 10% carbon dioxide and less than most component was nitrogen was postulated to be the most common gas within this stone. [2,5] The gas may form during gallstone development when fissures fill with bile, fluid, or gas.2 It may be produced by the stone itself or enter from the intestine.² Some gas gets trapped inside stones due to internal fissures or negative pressure during formation. [2]

Interestingly, the present case did not have gallstones when he underwent abdominal computed tomography for evaluation of trauma. Little et al. reported that among 73 patients who did not have gallstones on abdominal ultrasound, 12 of 47 who underwent major abdominal surgery had gallstones within 14-36 months after surgery, compared with 0 of 26 who did not undergo such surgery. [6] Major abdominal surgery may accelerate the development of gallstones in some patients. It has been suggested that laparotomy may affect bile secretion and promote gallstone formation.

4. Conclusion

We reported a case of a 41-year-old man who presented with adhesive ileus, during the evaluation of which an incidental gas-containing gallstone was identified on the CT. Owing to the rarity of such findings, we conducted a literature review and discussed potential pathophysiological mechanisms contributing to the formation of gas-containing gallstones.

ACKNOWLEDGEMENTS

This work was supported in part by a Grant-in-Aid for Special Research in Subsidies for ordinary expenses of private schools from The Promotion and Mutual Aid Corporation for Private Schools of Japan.

Conflict of Interest

We do not have conflict of interest to declare.

Contribution of Authors

YY wrote the manuscript with support from RT, CM, NT, & KN.

References

[1]   | Jones MW, Weir CB, Ghassemzadeh S. Gallstones (Cholelithiasis). StarPearls Last Update: August 17, 2024.
[2]   | Huerta S, Kakati R, Lanier H. Gas-Containing Biliary Calculi: Case Series and a Systematic Review. Am Surg. 2023 Jun; 89(6): 2656-2664.
[3]   | Marshall-Webb M, Fosh B. Gas-containing gallstones: a radiological finding. ANZ J Surg. 2017 Dec; 87(12): E323-E324.
[4]   | Sitaridis K, Domi I, Nathanailidou M, Chatzigiannis G, Boulas KA, Sourtse G, Hatzigeorgiadis A. Air in gallbladder: Emphysematous cholecystitis or else? Clin Case Rep. 2023 Mar 27; 11(3): e6391.
[5]   | Kommerell, B., and Wolpers, C. Gashaltige Gallensteine. Fortschr Rontgenstr. 1938; 58, 156-174.
[6]   | Little JM, Avramovic J. Gallstone formation after major abdominal surgery. Lancet. 1991 May 11; 337(8750): 1135-7.