The usefulness of microscopic bile examination in the evaluation of patients with upper abdominal pain

Background: Biliary microlithiasis is a collection of cholesterol and calcium bilirubinate crystals and is known to cause biliary colic, acute pancreatitis and acute cholecystitis. In some of these patients biliary microlithiasis has been found. Objectives: To estimate the incidence of biliary microlithiasis in patients with upper abdominal pain and negative imaging tests. Methods: A prospective analysis of bile was studied in 50 patients. A positive result was the identification of cholesterol crystals or calcium bilirubinate clumps. Results: In the 50 patients studied, 7 patients were found to have microlithiasis in bile. Conclusion: Microscopic examination of bile for biliary microlithiasis is a simple and safe technique and must be done in patients with upper abdominal pain who have normal blood tests, negative imaging tests and normal upper gastrointestinal endoscopy. Biliary microlithiasis is the probable cause of upper abdominal pain in some of these patients.