Evacuation of Gall Bladder in Female Patients with Pernicious Anemia

Abstract

In an earlier study 1 it was observed that in male patients with pernicious anemia the rate of evacuation of the gall bladder was not significantly retarded by the disease, but that in a surprisingly large proportion of the cases studied roentgenologically, the gall bladder could not be visualized, notwithstanding the use of the intravenous method and the absence of any gall bladder history. Accordingly it seemed desirable to examine a comparable number of female patients.

The present report is based upon cholecystographic studies of 48 consecutive, unselected patients with pernicious anemia (23 males and 25 females). In this group, 42% could not be visualized (35% of the males and 48% of the females). Also, a review of the 31, 311 necropsies recorded by the Department of Pathology for the 15-year period between 1926 and 1940, showed that of the 105 individuals having pernicious anemia, 32.4% had had either cholecystitis or cholelithiasis (or both) or had had the gall bladder removed. Furthermore the incidence of gall bladder disease increased progressively with age to the 8th decade—whereas Blalock 2 has shown that the greatest percentage of cases of biliary disease occurs in the fifth decade. These figures suggest that pernicious anemia increases the incidence of gall bladder disease and may have an etiological relation to it.

Evacuation of the gall bladder in 12 female patients (average age, 58 years) showed marked retardation over the group of female controls 3 (average age, 65 years); for in the first 40 minutes after the standard meal, the pernicious anemia group had evacuated only 71.5% of the contents of the gall bladder as against 84% by the controls. The difference is statistically significant, being nearly 3 times the standard error.