In discussing the vascular spread of carcinoma of the gallbladder, it is necessary to know the anatomy of the venous drainage of this organ. This work, using corrosion liver casts of 52 cases, was performed to study the venous drainage of the gallbladder. Almost all the cholecystic veins entered the adjacent substance of the liver and emptied into the portal circulation in the liver. In one case, however, cholecystic vein entered the main portal vein directly.
The cholecystic vein was divided into two groups; veins on the hepatic side and veins on the peritoneal side. The cholecystic vein on the hepatic side, which was found in 33 cases of the 52 liver casts, entered the quadrate lobe of the liver and terminated in the portal brunches of S₄ and/or S₅. On the other hand, cholecystic veins on the peritoneal side, which was found 38cases of the 52 liver casts, traversed Calot's triangle along with cholecystic artery and terminated in portal branches. Although the termination of cholecystic veins on peritoneal side had many variations,13 cases terminated in portal branches of the right anterior segment of the liver.

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We investigated preclinically how a shock wave induced tissue damage using mongrel dogs. Tissue damage in the lung, liver, and gallbladder after shock wave application to each organ was examined according to an experimental protocol without stone implantation. We found lung bleeding, edema around portal veins, and submucosal bleeding of the gallbladder. Next 100-500 shock wave applications had been administered to the implanted stones in the gallbladders of 7 dogs. All the stones were disintegrated and the tissue damage was reversible in all cases except the lung bleeding. It was assumed that high pressure of shock focusing may induce lung bleeding, and cavitation phenomenon may result in periportal edema in the liver. And from our model experiment using gelatin, it applies that the micro-liquid jet induced in an air bubble by a shock wave may damage tissue. As a result the high pressure generated by shock focusing, cavitation phenomenon and the micro-liquid jet may play an important role in tissue damage.

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A 69-year-old female was operated on for her gallstone in a local hospital 10 days prior to this admission when the laparotomy revealed that a gallbladder tumor had widely invaded to the liver, omentum and transverse colon. For secondary radical operation, she was admitted to the University Hospital on September 4, 1987.
On this admission, the patient was diagnosed to have gallbladder tumor with gallstones and intrahepatic hematoma. Cholecystectomy with right segmental hepatectomy and transverse colectomy was carried out on September 22. On the 10 th postoperative day, leukemoid reaction and massive intraabdominal bleeding from peritoneal dissemination occured. On the 39 th postoperative day, she expired with clinical features of DIC. The tumor of the gallbladder was histologically diagnosed as so-called carcinosarcoma, namely undifferentiated carcinoma.
The characteristic clinical features in this case were leukemoid reaction and massive bleeding. Recent several reports similar to this case have regarded the tumor influencing hematopoietic system and producing colony stimulating factor, resulting in leukemoid reaction and massive bleeding from the tumor.

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