J Moreaux1, J M Roux. 1. Centre Médico-Chirurgical de la Porte-de-Choisy, Paris.
Abstract
OBJECTIVES: This study is a retrospective analysis of clinical symptoms and operative findings in 16 patients with limy bile (mean age: 47.3 years, M/F ratio: 1/7) operated on over a 25-year period. METHODS: The patients were separated into two groups: patients with limy bile limited to the gallbladder and those with limy bile extending to the common bile duct. RESULTS: In the group of patients with limy bile in the gallbladder (n = 11), previous attacks of biliary pain were present in 9 and the gallbladder was entirely inactive in 9; an elective cholecystectomy was performed; an impacted stone was found in the neck of the gallbladder (n = 5) or in the cystic duct (n = 6), and the intraoperative cholangiogram was normal. The material deposited in the gallbladder was characteristically creamy or dense, white or yellow-brown, and consisted of calcium carbonate. The patients with limy bile extending to the common duct (n = 5) were admitted with acute pain and jaundice, and operated on a few days later. In the common bile duct, limy bile was associated with small stones (n = 4). CONCLUSION: Abdominal radiographs are sufficient to identify limy bile. The presence of this condition in the gallbladder is always associated with biliary lithiasis and the obstruction of the cystic duct. The presence of limy bile in the common bile duct is due to the migration of impacted stone and calcareous material deposited in from the gallbladder. Surgical treatment is only necessary in patients with specific biliary symptoms.
OBJECTIVES: This study is a retrospective analysis of clinical symptoms and operative findings in 16 patients with limy bile (mean age: 47.3 years, M/F ratio: 1/7) operated on over a 25-year period. METHODS: The patients were separated into two groups: patients with limy bile limited to the gallbladder and those with limy bile extending to the common bile duct. RESULTS: In the group of patients with limy bile in the gallbladder (n = 11), previous attacks of biliary pain were present in 9 and the gallbladder was entirely inactive in 9; an elective cholecystectomy was performed; an impacted stone was found in the neck of the gallbladder (n = 5) or in the cystic duct (n = 6), and the intraoperative cholangiogram was normal. The material deposited in the gallbladder was characteristically creamy or dense, white or yellow-brown, and consisted of calcium carbonate. The patients with limy bile extending to the common duct (n = 5) were admitted with acute pain and jaundice, and operated on a few days later. In the common bile duct, limy bile was associated with small stones (n = 4). CONCLUSION: Abdominal radiographs are sufficient to identify limy bile. The presence of this condition in the gallbladder is always associated with biliary lithiasis and the obstruction of the cystic duct. The presence of limy bile in the common bile duct is due to the migration of impacted stone and calcareous material deposited in from the gallbladder. Surgical treatment is only necessary in patients with specific biliary symptoms.
Authors: Sang Heon Lee; Jong Ho Moon; Hyun Jong Choi; Hyung Ki Kim; Young Deok Cho; Moon Sung Lee; Chan Sup Shim Journal: Gut Liver Date: 2009-12-31 Impact factor: 4.519