Transmural fluid movement in the freshly excised human gallbladder.

Direct information concerning the incidence and nature of gallbladder dysfunction in symptomatic cholethiasis was obtained by examining the rate and direction of transmural fluid movement in the freshly excised gallbladder. Each specimen was emptied of bile, cannulated and filled with a measured volume of bicarbonated Ringer's solution, suspended in the same solution at 37 degrees C., gassed with 95 per cent oxygen and 5 per cent carbon dioxide and weighed at ten minute intervals for at least one hour. Of the 42 human gallbladders examined, concentrating activity, ranging from 1 to 20 per cent of intraluminal volume per hour, was found in 14 and no activity in 17. Direction of fluid transport was found to be completely reversed in 12 additional gallbladders, four of which presented as hydrops. Histologic alterations ranged from mild to severe and could not be correlated with functional status. Application of indomethacin to the solution bathing both surfaces of 13 nonfunctioning, or partially functioning, gallbladders restored or increased function in eight. It can be concluded from this study that the concentrating activity is retained in approximately 30 per cent of patients with symptomatic cholelithiasis; cholesterol stones form in gallbladders with normal concentrating activity; the spectrum of gallbladder dysfunction ranges from simple loss of concentrating activity to hydrops, the latter reflecting complete loss of this activity plus secretion into the lumen, and dysfunction is probably induced by chemical mediators of inflammation rather than by structural changes.