CHOLECYSTITIS AND CYSTIC DUCT OBSTRUCTION

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Abstract
Large gallstones in man consisting of a high percentage of calcium carbonate have been but rarely reported and no associated factors have been mentioned as specifically influencing their formation. In a study of seven cases diagnosed as such, the observation was made that in every case the cystic duct was obstructed by a cholesterol-bile pigment, or cholesterol stone, indicating that the duct obstruction was a precursor to and a determining factor in calcium carbonate stone formation in the gallbladder. Following this obstruction the calcium carbonate was thrown out in large quantities, forming either a separate stone or a mold of the gallbladder which incorporated preexisting cholesterol-bile-pigment stones. A thick mucinous suspension of calcium carbonate may be found which has been described as "calcium milk bile" by Volkmann.1In some instances the deposit of calcium carbonate produced the roentgenographic appearance of very markedly concentrated tetiothalein sodium N. N. R. in

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