GALLBLADDER VOLUME IN PATIENTS WITH COMMON HEPATIC DUCT DILATATION - AN EVALUATION OF COURVOISIERS SIGN USING ULTRASONOGRAPHY

To evaluate the usefulness of Courvoiier's sign in ultrasonography, ga llbladder size in patients with common hepatic duct dilatation was mea sured using the ellipsoid method during ultrasonographic examination. During a 6-month period 24 patients with malignant obstructions (6 wit h carcinoma of the ampulla of Vater, 9 with pancreatic head tumors, 5 with carcinoma of the bile duct, and 4 with malignant lymphadenopathy) , 50 patients with calculous obstructions, and a group of 50 normal co ntrol patients were examined in this study. Gallbladder volumes were l arger in patients with biliary tract dilatation (88.8+/-6.8 ml) than i n the control group (34.3+/-2.8 ml) (p<0.01). Although the duration an d total serum bilirubin level were higher in patients with malignant o bstructions, the gallbladder volumes were the same in these two groups (93.0+/-11.3 ml versus 86.7+/-8.5 ml). A linear relationship was foun d between gallbladder volume and total serum bilirubin in patients wit h malignant biliary obstructions (r=0.6, p<0.001) and in patients with calculous biliary obstructions without gallbladder stones (r=0.68, p< 0.001). We hypothesized that the gallbladder volume is irrelevant in d ifferentiating the nature of the biliary tract dilatation and that the gallbladder size is dependent on the degree of biliary obstruction wh en the gallbladder is not afflicted by fibrosis.