A rare case of cholesterol and pigment gallstones in the gallbladder of a single patient: a morphologic-chemical comparison

The aim. This article presents a rare clinical case of the simultaneous formation of cholesterol and pigment (black) gallstones in a single patient. Materials and methods. A comprehensive structural and chemical analysis of the extracted stones was performed using X-ray microtomography, X-ray diffraction (XRD), X-ray fluorescence analysis (XRF), infrared (IR) and Raman spectroscopy. Results. The study revealed distinct differences in the structure, chemical composition, and degree of mineralization between the different stone types. Possible pathogenetic mechanisms behind the concurrent formation of morphologically distinct gallstones are discussed, with emphasis on local changes in the biliary environment. Conclusion. The findings highlight the importance of an integrated analytical approach in cases of atypical cholelithiasis presentation.