Abstract
Because of the prevalence of disease of the gall bladder and bile ducts, the nature of biliary colic is of extraordinary interest. Recently we have had an opportunity to conduct studies of biliary tract pain upon unanesthetized human subjects, and our findings form the basis for this report.
Patients who had undergone choledochotomy and intubation of the common bile duct several weeks or months previously voluntarily submitted themselves as subjects for these studies. As a preliminary step the condition of the biliary tract was determined by cholangiographic examination. Pain was then produced by sudden distention of the ducts by the introduction of sterile physiological saline solution under pressures varying from 50 to 100 cm. of water. This was accomplished by attaching an infusion flask containing saline solution to the T-tube leading into the common bile duct, and adjusting the pressure by elevating or lowering the flask. The patients were then observed closely to determine the effects of the procedure. Although they were interrogated concerning their sensations during the period of the experiments, leading questions were carefully avoided. In fact, much of the information was volunteered by the subjects without the necessity for questioning.
Among the 15 patients studied, all suffered deep epigastric or right upper quadrant pain following sudden distention of the bile ducts. In 8 of the cases the sensation remained localized while in the remaining 7 there was radiation to the interscapular or right subscapular region. The deep epigastric or right upper quadrant pain occurred earlier than the referred pain by many seconds.
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