Virtual autopsy investigation of gallstones in an 18th century Sicilian mummy
Main Article Content
Keywords
Gallstones, Mummies , Sicily, Paleopathology, Paleoradiology
Abstract
Gallstones represent a relatively rare finding in ancient human remains, and they are almost always related to high social classes. We report gallbladder stone disease detected by computed tomography-guided virtual autopsy in an 18th century natural mummy found in the Church of Sant’Anna in Modica, south-eastern Sicily. The mummified body was conservatively investigated by external examination and computed tomography (CT) scanning. 3D rendering and virtual autopsy approach enabled us to recognize multiple stones in the gallbladder, whereas densitometry allowed us to reconstruct the exact stone morphology and establish the chemical composition. The mummy belonged to an anonymous plump elder man with poor dental status, calcified lung nodules, pelvic phleboliths, and severe osteoarthritis of the spine and the right hip. Seven gallstones measuring 1.3 to 2.0 cm in largest diameter were observed. They had ellipsoid shape and inhomogeneous morphology with central hypodense cores and density values ranging from 70 to -289 Hounsfield Units (average: -40). These features suggested combined cholesterol gallstones. Gallstones may be easily recognized in natural mummies through a CT-guided virtopsy approach, whereas densitometry may help to establish their chemical composition. In the present case, cholesterol-based stones were probably due to dietary factors and genetic predisposition like their modern counterparts. Along with the other pathological findings (obesity, phleboliths, dental status) gallbladder stones represent a good bioanthropological marker of high social class.
References
Beal, J. M. (1984). Historical perspective of gallstone disease. Surg Gynecol Obstet, 158(2), 181-189.
Biehler-Gomez, L., Maderna, E., Brescia, G., Cappella, A., Rizzi, A., Cattaneo, C. (2019). “Aged” autopsy gallstones simulating dry bone context: a morphological, histological and SEM-EDS analysis. Int J Paleopathol, 24: 60-65. https://doi.org/10.1016/j.ijpp.2018.09.004
Buikstra, J. E., & Ubelaker, D. (1994). Standards for data collection from human skeletal remains. Research series no. 44. Arkansas archeological survey, Fayetteville.
Capasso, L., Kennedy, K. A. R., & Wilczak, C. A. (1999). Atlas of occupational markers on human remains. Edigrafital, Teramo.
Cárdenas-Arroyo, F., & Martina, M. C. (2019). Two findings of gallstones in archaeological mummies from Colombia. Int J Paleopathol, 24, 53-59. https://doi.org/10.1016/j.ijpp.2018.09.003
Cariati, A. (2015). Gallstone classification in Western countries. Indian J Surg, 77(Suppl 2), 376-380. https://doi.org/10.1007/s12262-013-0847-y
Caroli, A., Del Favero, G., Di Mario, F., Spigariol, F., Scalon, P., Meggiato, T., Zambelli, C., & Naccarato, R. (1992). Computed tomography in predicting gall stone solubility: a prospective trial. Gut, 33(5), 698-700.
Cesarani, F., Martina, M. C., Boano, R., Grilletto, R., D’Amicone, E., Venturi, C., & Gandini, G. (2009). Multidetector CT study of gallbladder stones in a wrapped Egyptian mummy. RadioGraphics, 29(4), 1191-1194. https://doi.org/10.1148/rg.294085246
Chen, D., Huang, J.-F., Chen, J.-M., You, Z.-Q., Wang, H., Wang, X.-S., Yan, X.-X., Luo, & X.-G. (2019). Autopsy and forensic study on a rare human corpse preserved over two thousand years: the Mawangdui ancient cadaver. Biopreserv Biobank, 17(2), 105-112. https://doi.org/10.1089/bio.2019.0001
Ejlskov Pedersen, C. C., Villa, C., Asingh, P., Thali, M. J., & Gascho, D. (2021). Looking deep into the past – virtual autopsy of a Mongolian warrior. For Imaging, 25, 200455. https://doi.org/10.1016/j.fri.2021.200455
Ellis, P. H. (2019). The story of gallstones and their treatment. J Perioper Pract, 29(11), 382-384. https://doi.org/10.1177/1750458919838450
Fornaciari, G., Pollina, L., Tornaboni, D., & Tognetti, A. (1989). Pulmonary and hepatic pathologies in the series of mummies of S. Domenico Maggiore at Naples (XVI century). Proceedings VII European Meeting of the Paleopathology Association (Lyon, September 1988). Solfanelli, Chieti, 89-92.
Fornaciari, G. (2006). Le mummie aragonesi in San Domenico Maggiore di Napoli. Med Secoli, 18(3), 843-864.
Glenn, F. (1971). Biliary tract disease since antiquity. Bull N Y Acad Med, 47(4), 329-350.
González-Reimers, E., González-Arnay, E., Castañeyra-Ruiz, M., & Arnay-de-la-Rosa, M. (2018). Identifying small pelvic inclusions through SEM technology. Int J Paleopathol, 22, 92-96. https://doi.org/doi: 10.1016/j.ijpp.2018.06.003
Gray, P. H. K. (1967). Two mummies of ancient Egyptians in the Hancock Museum, Newcastle. Med Radiogr Photogr, 43(2), 75-78.
Lammert, F. (2022). Gallstones: the thing in itself. Clin Liver Dis, 20(Suppl 1), 57-72. https://doi.org/10.1002/cld.1269
Long, G. S., Klunk, J., Duggan, A.T., Tapson, M., Giuffra, V., Gazzè, L., Fornaciari, A., Duchene, S., Fornaciari, G., Clermont, O., Denamur, E., Golding, G. B., & Poinar, H. (2022). A 16th century Escherichia coli draft genome associated with an opportunistic bile infection. Commun Biol, 5(1), 599. https://doi.org/10.1038/s42003-022-03527-1.
Mariotti V., Facchini F., & Belcastro M. G. (2004). Enthesopathies - proposal of a standardized scoring method and applications. Coll Antropologicum, 28(1), 145-159.
Mariotti V., Facchini F., & Belcastro M. G. (2007). The study of entheses: proposal of a standardised scoring method for twenty-three entheses of the postcranial skeleton. Coll Antropologicum, 31(1), 291-313.
Mörner, C. T. (1936). Undersökning av i gotländsk stenåldersgrav funna konkrement. Sven Läkartid, 33, 1465-71.
Munizaga, J., Allison, M. J., & Paredes, C. (1978). Cholelithiasis and cholecystitis in pre-Columbian Chileans. Am J Phys Anthropol, 48(2), 209-212.
Murphy, M. C., Gibney, B., Gillespie, C., Hynes, J., & Bolster, F. (2020). Gallstones top to toe: what the radiologist needs to know. Insights Imaging, 11(1), 13. https://doi.org/10.1186/s13244-019-0825-4
Polverosi, R., Sbeghen, R., Zambelli, C., Caracciolo, F., Spigariol, F., & Caroli, A. (1992). [Role of computerized tomography in the densitometric assessment of lithiasis of the gallbladder]. Radiol Med, 84(4), 387-392.
Profico, A., Tafuri M. A., Di Vincenzo, F., Ricci, F., Ottini, L., Ventura, L., Fornaciari, G., Di Lernia, S., & Manzi, G. (2020). Medical imaging as a taphonomic tool: the naturally mummified bodies from Takarkori rock shelter (Tadrart Acacus, SW Libya, 6100-5600 uncal BP). J Cult Heritage Manag Sustain Dev, 10(2), 144-156. https://doi.org/10.1108/JCHMSD-06-2019-0066
Salucci, S., Traversari, M., Valentini, L., Versari, I., Ventura, L., Giampalma, E., Righi, E., Petrella, E., Billi, A., Gobbi, P., Pasquinelli, G., & Faenza, I. (2024). Anatomage table and environmental scanning electron microscopy (ESEM) as anatomical tools for studying mummified bodies. (Unpublished data).
Sanchez, J. A., & Etxeberria, F. (1991). Renal and biliary calculi: a palaeopathological analysis. Int J Osteoarchaeol, 1(3-4), 231-234.
Steinbock, R. T. (1990). Studies in ancient calcified soft tissues and organic concretions. III: gallstones (cholelithiasis). J Paleopathol, 3(2), 95-106.
Uldin, T. (2017). Virtual anthropology – a brief review of the literature and history of computed tomography. For Sci Res, 2(4), 165-173. https://doi.org/10.1080/20961790.2017.1369621
Ventura, L., Fornaciari, G., Calabrese, A., Arrizza, L., & Fornaciari, A. (2020). Paleopathology of a 19th century mummy of a nobleman from Popoli, central Italy. Med Historica, 4(1), 29-34.
Ventura, L. (2021). Advanced morphological and analytic investigations of mummies. The pathologist’s approach. Med Secoli, 33(3), 417-430.
a. Ventura, L., Romeo, G., Grimaldi, B., Causarano, A., Caruso, C., Voi, G., & Pensiero, V. (2022). The “Queen of the Moors”. Paleopathological investigation of a natural mummy from Scicli, South-Eastern Sicily. Pathologica, 114(2), 152-158. https://doi.org/10.32074/1591-951X-256
b. Ventura, L., Arrizza, L., Quaresima, R., & Capulli, M. (2022). Multidisciplinary investigation of an ancient renal stone in a mummy from Popoli, central Italy. Pathologica, 114(4), 339-341. https://doi.org/10.32074/1591-951X-260
Ventura, L., Pensiero, V., Romeo, G., Causarano, A., Giallongo, G., Caruso, C., Voi, G., & Traversari, M. (2024). Paleoradiological survey through virtopsy of the natural mummies from the church of Sant’Anna in Modica, south-eastern Sicily. Coll Antropol, 48 (1), in press.
Wee, S., Lee, Y. H., Kim, Y. R., Yoon, K. H., & Park, D.-E. (2021). Determination of gallstone composition using dual-energy computed tomography: an ex-vivo study. Korean J Abdom Radiol, 5(1), 42-52. https://doi.org/10.52668/kjar.2021.00080
Wei, O. (1973). Internal organs of a 2100-year-old female corpse. Lancet, 2(7839), 1198.
Weisberg, H. F. (1984). Pathogenesis of gallstones. Ann Clin Lab Sci, 14(4), 243-251.