Morphology of cholecystitis and gallstone formation.

Abstract

One thousand gallbladders received from cholecystectomies were analyzed microscopically. Regarding the clinical symptoms the morphological signs of acute and chronic cholecystitis were established. Microscopic changes typical of acute cholecystitis were oedema, haemorrhage and necrosis; and of chronic cholecystitis, sclerosis, presence of haemosiderin pigment and scars. The initial injury of the gallbladder is caused by an angioneurotic reaction (vasospasm and vasodilation) taking place in the bed of the cystic artery during the biliary colic. Acute lesions in the gallbladder are the result of a stress-reaction which takes place in the wall of the biliary tract. Microscopic analysis of the content of removed gallbladder displayed the beginning of gallstone formation. The gallstones are considered a secondary complication of processes which occur in the gallbladder wall during biliary colic. The succession of separate factors which have a role in cholecystitis and cholelithiasis are specified. A new therapeutic approach, treatment with antihistaminics is proposed, to block the angioneurotic reaction and to prevent the progression of biliary tract disease and the formation of gallstones.