The biliary tract lesion of duodenal ulcer

Summary

The differential diagnosis between surgical cholecystitis and duodenal ulcer with an associated oleaginous catarrh of the bile ducts or transient cholecystatony can usually be made by the combination of duodenobiliary drainage and fractional gastric analysis. Frank cholecystitis or biliary colic, requiring surgical intervention, rarely demand confirmatory studies when the syndrome is known to be classical. Borderline patients, however, with ulcer syndromes masked by a superimposed biliary syndrome require careful studies in order to prevent the non-beneficial removal of anatomically normal gall bladders or the injurious prohibition of fats in their diets.

The diagnosis of duodenal ulcer rests upon the demonstration of acid dyskinesia, with or without hyperchlorhydria, by physiological fractional gastric analysis, and the detection of red mucus from the duodenal or gastric zones. The diagnosis of the associated biliary tract lesion of duodenal ulcer rests upon the identification of oleaginous material, oleaginous mucus, or coarse, spiral, fragmented mucus in abundance in the sediments from duodeno-biliary drainage, and on the demonstration of the initial absence of a gall bladder response restored to normal by repeated oil drainages or by an adequate fat diet.

Neglect of the biliary tract lesion of duodenal ulcer, and especially a fat restricted diet, may lead eventually to surgical cholecystitis.

Duodenal ulcer appears to be a widely prevalent disease in individuals of both leptosomic and pyknic types.