Duodenal Drainage of the Human Gall Bladder.

Abstract

During the last 5 years both the theory and the efficacy of the Meltzer-Lyon test have been frequently challenged, but as yet no adequate measurements of the amount of bile discharged from the gall bladder following the injection of MgSO₄ and other substances into the duodenum, seem to have been made.

In view of the consensus of opinion that MgSO₄ is not absorbed by the intestine and believing that evacuation of the gall bladder might be induced by mechanical stimulation, we injected air into the duodenum through a Reyfuss tube and then x-rayed the patient at short intervals—computing the volumes of the gall bladder according to the method employed in previous publications. 1 In 3 out of 4 individuals subjected to this procedure, the gall bladder showed measurable reduction in size after inflation of the duodenum (Fig. 1). In one case (the largest gall bladder we have ever seen) the reduction was considerable, from 96 down to 71 cc. (A. R., Fig. 1). In 2 other cases (E. I. and M. A.) it amounted to only a few cc., and in the fourth case (G. A. K.), dilation of the gall bladder ensued—a reverse effect which we interpret as a reflex inhibition of the gall bladder, due to sudden and forcible inflation of the duodenum. (cf. case B. B., Fig. 1 of accompanying paper). 2

In each of the 4 cases, egg yolk was subsequently injected into the duodenum in order to test the motility of the gall bladder. It is interesting to note that when thus administered, this food induces as effective a phase of contraction as when taken by mouth.

Having ascertained the reaction of the gall bladder to inflation of the duodenum, concentrated MgSO₄ was then tried.