BILE-DUCT PRESSURE, HORMONAL INFLUENCE AND RECURRENT BILE-DUCT STONES

An obstacle to the outflow from the bile duct not only increases bile duct pressure but also facilitates the formation of primary bile duct stones. The bile duct pressure, an indicator of the balance between bi le inflow and outflow, was studied postoperatively under similar condi tions in 123 patients, who had been operated on for bile duct stones. Secondary bile duct stones had been present in 86 patients (group CC) and primary stones in 26 (group C), while 11 without sphincter of Oddi function were used as a control group. The basal bile duct pressure w as similar in groups CC and C, but significantly lower in the controls . Intraductal injection of saline solution caused a similar increase i n bile duct pressure in groups CC and C, but not in the controls. Intr avenous administration of secretin and somatostatin increased the bile duct pressure in groups CC and C, while a ''normal'' response to chol ecystokinin, a decrease in bile duct pressure, was observed only in gr oup CC. The ''abnormal' response to cholecystokinin found in group C i ndicates a motor dysfunction of the sphincter of Oddi, which may have been responsible for, or at least contributed to, the formation of rec urrent bile duct stones in this group.