Stone Formation in the Non-Contracting Gall Bladder.

Abstract

It has been reported previously that stones could be produced experimentally by interference with the normal mechanism for filling and emptying the gallbladder, resulting in stasis and over-concentration of bile. 1 The observations here presented tend to confirm that finding and add further evidence as to the mode of formation of gall stones.

In one cat while the gallbladder was being filled with iodized oil it was accidentally stripped away from the liver bed nearly down to the cystic duct. The gallbladder containing iodized oil was then replaced in its fossa and the abdomen closed. The next day the viscus had expelled most of the oil and partly refilled with bile, as evidenced by a shadow form with flecks of oil about the sides. The expulsion of the oil was perhaps due to rapid congestion and edema from the injury, which later subsided, allowing partial refilling of the viscus. This shadow form of the gallbladder produced by the radio-opaque oil adherent to its wall remained constant for 11 days, except that it decreased slowly in size to about two-thirds its original volume. A fat meal on the second day produced no change in the shadow. At necropsy the gallbladder was found to be filled with a very hard black cast made up undoubtedly of inspissated bile. The cystic duct, where there had probably been less stasis, was filled with a black putty-like mass which hardened like the other upon being dried. The vesicle was thin and pale and tense over the stone. Miscroscopic examination showed a good deal of organizing tissue between the gallbladder and the liver. The wall of the viscus and the niucosa, however, were fairly normal, indicating that concentration of bile could have taken place. The whole sequence of events leaves the impression that induced stasis associated with concentration over a period of several days produced a pigment (or mixed pigment) stone.