Observations Following Distension of the Gallbladder and Common Duct in Man

Abstract

The susceptibility of the gallbladder and common duct to overdistension from various causes makes them a common source of visceral and referred pain. The location of pain in gallbladder disorders varies and there is nothing in its character to differentiate it from pain resulting from a change in the state of the common duct. Patients with biliary disease commonly complain of chronic indigestion and, in addition, their pain may be referred to the interscapular and infrascapular regions, right upper quadrant, epigastrium and occasionally to the left side. Various theories have been proposed to explain the mechanism of this “referred” visceral pain.^{1, 2}

Our observations were made on six women operated upon for gallbladder disease. Their complaints varied from chronic indigestion to typical, as well as bizarre, radiation of the pain. Chronic cholecystitis and choleliathiasis were found in every case at operation.

Method. In 4 patients the gallbladder was exposed and the stones removed after a short gas-oxygen anesthesia. A sterile rubber balloon, carried on a sterile hollow metal rod, was inserted into the gallbladder. The rod was connected to a blood pressure apparatus through which the balloon could be inflated and the amount of pressure recorded. The fundus of the gallbladder was then sealed around the rod by several sutures and the organ replaced in the abdomen. The edges of the wound were held in approximation and all gauze and retractors removed from its margins to avoid additional painful stimuli. The distension was carried out after the patient had recovered sufficiently from the short anesthesia to answer questions intelligently. In one patient the observations were made following exposure of the gallbladder under local infiltration anesthesia of the right upper quadrant.