Five years of gallbladder disease at autopsy in a general hospital: A review of 2,450 consecutive routine autopsies

Abstract

Gallbladder disease in 2,450 consecutive autopsies during a five-year period at a general hospital were reviewed: 1. 1. “Incidental” gallbladder disease with stone was found in 271 cases (11 per cent). With each decade this figure increased, reaching 25 per cent in the eighth decade. Symptoms referable to the gallbladder had been elicited in only 4 per cent of cases. 2. 2. Seventy (25 per cent) of the 271 cases of gallbladder disease were “severe” in degree. Severe, acute pathological conditions accounted for the highest percentage of “gallbladder deaths,” and perforation played a predominant rôle. Severe chronic disease was manifested principally by cases of hydrops of the gallbladder and of marked contracted chronic cholecystitis and cholelithiasis. Only one death was due to “gallbladder disease” in this group. Only five of seventy patients who showed severe gallbladder disease at autopsy showed any clinical symptoms referable to the gallbladder. 3. 3. Moderately advanced and minimal gallbladder conditions comprised 16 per cent and 59 per cent, respectively, of the entire series and accounted for no deaths. 4. 4. Obstruction by stone was the most common lesion of the biliary ducts associated with cholecystitis in this series. The “invasion” mechanism of carcinomatous obstructive jaundice is emphasized. 5. 5. Inflammation of the gallbladder gave rise to few instances of liver disease in this series. Biliary cirrhosis and cholangitis occurred in a relatively small number of cases. 6. 6. Pancreatic disease resulting from acute or chronic gallbladder disease was not found frequently. 7. 7. No appendiceal abnormality of any significance in relation to gallbladder disease was found. 8. 8. Coronary sclerosis and general arteriosclerosis are not significantly more common among patients with gallbladder disease.