RESEARCHES ON CHOLELITHIASIS

Abstract

As a part of researches on Cholelithiasis in Matsukura Surgical Clinik, the author has made histological studies in detail on the gall-bladders removed from 127 patients clincally diagnosed as cases of cholelithiasis. and cholecystitis.
Attempts have been made to correlate these findings with clinical observations, and the results obtained may be summarized as follows.
1) This series of 127 cases consists of 46 males (41 cases with stones and 5 without) and 81 males (71 patients with stones and 10 without), the ratio thus being 1: 1.7. In age the greated majority was between 3/and 60 years, the peak being in the forties. However, there were 19 aged patients over 61 years, while 9 patients were under 30 years. Nearly two-thirds of the patients were operated upon within 2 years after the onset of the disease, while the remainder were not so treated in as long periods as 5 or 10 years. Furthermore, there were 4 out of 15 instances without the stones with a lapse of over 5 years.
2) There were 112 instances of stone-formation and 15 without in this series of 127 cases. Of the former, cholesterol stones were seen in 62 cases (55%), bilirubin stones in 47 cases (42%), while inorganic stones were present only in two cases. The site formation for cholesterol stones (62 cases) was in the Gallbladder (48 cases or 77.4%) and in the common bile duct (14 cases or 23%), while for bilirubin stones (47 cases) in the gallbladder (22 cases or 46.8%) and in the common bile duct (25 cases or 53%). Inorganic stones in 5 cases were both in the gallbladder.
3) Icterus was noted in 73 (57.5%) of 127 cases but in 54 (42.5%) no icterus was detectable. In relation to the site of stone-formation, nearly one-half the total gallbladder cases presented icterus, of which 5 (7%) were markedly icterus. On the contrary, icterus was present in 27 (67.5%) of 40 cases with stones in the common bile duct, of which 10 (25%) cases were highly icteric, while 11 (26%) cases were without icterus. There were 4 (26.7 %) with icterus among 15 cases, in which no stone-formation was demonstrable, and one of these presented marked icterus.
4) In regard to the presence of bacteria in the bile, there were 63 (75%) out of 84 instances examined in which bacteria could be demonstrable. The frequency of positive findings was: 32 (91.4%) of 35 instances of bilirubin stone; 23 (61%) of 38 instances of cholesterol stones; 6 (67%) of 9 instances without stones; and both of 2 cases with inor ganic stones.
5) In cholecystitis with stone-formation, 11.5% showed acute inflammatory picturs, the same percentages markedly acute symptons, 20% combination of acute und chronic pictures, while the remaining 57%, only mildly chronic pictures. On the contrary, in cholecystitis without stone-formation, the majority (87%) presented mildly chronic symptoms, but a few (13%) showed highly acute pictures.
6) Symptoms varying from acute to chronic inflammation were noted in 42-45% ofstone cases in the gallbladders, but the rate was lower (33%) in patients with stones in the common bile duct.
7) In bilirubin cholelithiasis the inflammation of the gallbladder was marked in 50%, but on cholesterol cases the rate was lower (41%).
8) A parallel relationship was obtained between the number of white blood cells and the degree of gallbladder inflammation, but there were some instances showing no leukocytosis despite the presence of highly inflammatory symptoms.
9) Strawberry gallbladder was seen in 4 cases, of which 3 had cholesterol stones, all showing histological pictures of chronic cholecystitis.
10) The incidence of lymph nodule formation on the walls of gallbladder was 37.8%, being most frepuently seen in cases of markedly chronic inflammation, and the frepuency of its appearance was highest in the perimuscular connective tissue layer, followed by the mucous layer.