Memon Aijaz A, Soomro M Ishaque, Soomro Quratul-Ain
Department of General Surgery, Chandka Medical College Hospital and Shaheed Mohtarma Benazir Bhutto Medical University, Larkana.
J Coll Physicians Surg Pak. 2012 Jun;22(6):392-4.
According to Courvoisier's law; if gallbladder is palpable in a jaundiced patient, it is unlikely to be due to gallstones, because stones would have given rise to chronic inflammation and subsequently fibrosis of gallbladder therefore, rendering it incapable of dilatation. Conversely, the causes other than stone (principally tumours), would result in the distension of gallbladder, felt on abdominal palpation. However, in Courvoisier study of 109 cases of dilatation of gallbladder, 17 were due to impacted stones. Therefore, Courvoisier concluded that dilatation of gallbladder was rare with stones obstructing the common bile duct. Despite this fact it is always assumed that the palpable gallbladder is due to malignancy (pancreatic or periampullary etc.). Here, we report a rare case of palpable gallbladder in a jaundiced patient due to multiple cholelithiasis and a large choledocholithiasis causing obstruction of CBD.
根据库瓦西耶定律；如果黄疸患者的胆囊可触及，不太可能是胆结石所致，因为结石会引发慢性炎症，随后导致胆囊纤维化，从而使其无法扩张。相反，非结石性病因（主要是肿瘤）会导致胆囊扩张，在腹部触诊时可摸到。然而，在库瓦西耶对109例胆囊扩张病例的研究中，17例是由嵌顿结石引起的。因此，库瓦西耶得出结论，结石阻塞胆总管时胆囊扩张很少见。尽管如此，人们总是认为可触及的胆囊是由恶性肿瘤（胰腺或壶腹周围等）引起的。在此，我们报告一例黄疸患者胆囊可触及的罕见病例，病因是多发胆石症和一枚大的胆总管结石导致胆总管梗阻。
