Pathological Changes in the Gallbladder Wall Due to Action of Bile

Abstract

For a long time the local cytotoxic effect of bile and many of its components on tissue has been recognized. With the exception of the more resistant and adapted mucosa of the intestinal tract and the excretory ducts of the biliary tract, there are few instances in which the production of cellular injury does not occur when bile comes in contact with such tissue. This local action is to a large extent dependent upon the concentration of the bile or the several components of bile. For the most part it presents itself as edema, increased capillary permeability with extravasation of blood and direct tissue necrosis with fibroblastic proliferation and round cell infiltration chiefly of the monocytic series. This can be easily demonstrated when bile of various concentrations is injected intramuscularly or subcutaneously and the tissue studied at various time intervals.

Because of the failure of a purely bacteriological explanation of the etiology of cholecystitis to satisfy many of the experimental and clinical aspects of this disease, it has occurred to us that the local effects of bile might be of importance in this condition. That bile may act in this capacity in the production of cholecystitis has previously been suggested by Aronsohn and Andrews 1 and by Ravdin 2 and his co-workers. These investigators injected bile or bile salts into the gallbladder through the cystic duct or common duct and observed acute inflammatory changes in the wall. Cole 3 observed changes in the gallbladder wall following partial cystic duct obstruction. Because of the fact that acute cholecystitis is very rarely seen in the absence of cystic duct obstruction, it occurred to us that this factor must also be considered in the etiological aspects of this disease.