Experimental Hepatogenous Cholecystitis.

Gall bladder bile in dogs cultured in our laboratory has been shown by Rewbridge 1 to be almost invariably sterile.

In a series of experiments in which biliary stasis had been present for varying periods of time B. welchii and lesser numbers of cocci and B. coli were grown from the bile in 76% of cases. Biliary stasis had been produced not only by ligating the cystic duct, care being taken to avoid the cystic artery, but also by common duct ligation and by both procedures.

In most of these experiments not only were these bacteria present but marked evidences of cholecystitis were found. Gross specimens of these gall bladders revealed the interesting fact that the infection undoubtedly made its way into the gall bladder not through the bile or the blood stream but by direct extension from the liver. This could be seen by killing the dogs in various stages of the process. In the early stages (1-4 days), the gall bladders presented the picture of a cholecystitis only on the hepatic surfaces. The free peritoneal side at this period is thin, normal in appearance both grossly and histologically. The hepatic surface is thickened, often to 10 times normal and its wall shows edema and infiltration of leucocytes and round cells. Later the inflammation extends around the entire circumference of the viscus. The mucosa generally remains quite normal even in the later stages when the other layers of the wall show marked inflammation.

The work of Dragstedt 2 and later of Andrews 3 on the rich anaerobic flora of the liver has shown that these organisms are constantly present and it now becomes evident that in stasis they may make their way into the gall bladder in large numbers.