Courvoisier’s Gallbladder: Law or Sign?



Variously described as Courvoisier’s law, sign, or even gallbladder, this eponymous “law” has been taught to medical students since the publication of Courvoisier’s treatise in 1890.


We reviewed Courvoisier’s original “law,” the modern misconceptions surrounding it, and the contemporary evidence supporting and explaining his observations.


Courvoisier never stated a “law” in the context of a jaundiced patient with a palpable gallbladder. He described 187 cases of common bile duct obstruction, observing that gallbladder dilatation seldom occurred with stone obstruction of the bile duct. The classic explanation for Courvoisier’s finding is based on the underlying pathologic process. With the presence of gallstones come repeated episodes of infection and subsequent fibrosis of the gallbladder. In the event that a gallstone causes the obstruction, the gallbladder is shrunken owing to fibrosis and is unlikely to be distensible and, hence, palpable. With other causes of obstruction, the gallbladder distends as a result of the back-pressure from obstructed bile flow. However, recent experiments show that gallbladders are equally distensible in vitro, irrespective of the pathology, suggesting that chronicity of the obstruction is the key. Chronically elevated intraductal pressures are more likely to develop with malignant obstruction owing to the progressive nature of the disease. Gallstones cause obstruction in an intermittent fashion, which is generally not consistent enough to produce such a chronic rise in pressure.


We hope that reminding clinicians of Courvoisier’s actual observations will reestablish the usefulness of this clinical sign in the way he intended.

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  1. 1.

    Courvoisier LG (1890) Casuistich-statistische Beiträge zur Pathologie und Chirurgie der Gallenwege. Verlag von F.C.W, Vogel, Leipzig

    Google Scholar 

  2. 2.

    Verghese A, Dison C, Berk SL (1987) Courvoisier’s “law”—an eponym in evolution. Am J Gastroenterol 82:248–250

    PubMed  CAS  Google Scholar 

  3. 3.

    Ludwig Courvoisier (1843–1918). Courvoisier’s sign. JAMA 204:627 (1968)

  4. 4.

    Rhoads JE (1957) Pancreas. In: Allen JG, Harkins HN, Moyer CA, Rhoads JE (eds) Surgery: principles and practice. Pitman Medical Publishing, London, pp 715–740

    Google Scholar 

  5. 5.

    Ooi K, Merrett N (2004) Autoimmune pancreatitis in a patient presenting with obstructive jaundice and pancreatic mass. HPB (Oxford) 6:126–127

    Google Scholar 

  6. 6.

    Lim JH, Kim SY, Park CM (2007) Parasitic diseases of the biliary tract. AJR Am J Roentgenol 188:1596–1603

    PubMed  Article  Google Scholar 

  7. 7.

    Fournier AM, Michel J (1992) Courvoisier’s sign revisited: two patients with palpable gallbladder. South Med J 85:548–550

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    Lapointe R, Gamache A, Pare P (1984) Bile-duct cyst with cystlithiasis: a case report. Can J Surg 27:271–273

    PubMed  CAS  Google Scholar 

  9. 9.

    Viteri AL (1980) Courvoisier’s law and evaluation of the jaundiced patient. Tex Med 76:60–61

    PubMed  CAS  Google Scholar 

  10. 10.

    Munzer D (1999) Assessment of Courvoisier’s law. Saudi J Gastroenterol 5:106–112

    Google Scholar 

  11. 11.

    Watts G (1985) Courvoisier’s law. Lancet 2:1293–1294

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    Chung RS (1983) Pathogenesis of the “Courvoisier gallbladder”. Dig Dis Sci 28:33–38

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    Ginzburg L, Payson BA (1957) A variant of the Courvoisier syndrome in carcinoma of the gallbladder. Ann Surg 146:976–982

    PubMed  Article  CAS  Google Scholar 

  14. 14.

    Chen JJ, Changchien CS, Tai DI et al (1994) Gallbladder volume in patients with common hepatic duct dilatation: an evaluation of Courvoisier’s sign using ultrasonography. Scand J Gastroenterol 29:284–288

    PubMed  Article  CAS  Google Scholar 

  15. 15.

    Bromley PJ, Keller FS (2001) Images in clinical medicine: Courvoisier’s gallbladder. N Engl J Med 345:1542

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Verghese A, Berk SL (1986) Courvoisier’s law. Lancet 1:99

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    Schneiderman H (2004) It’s not the law. Can Med Assoc J 171:312

    Article  Google Scholar 

  18. 18.

    Woywodt A, Matteson E (2007) Should eponyms be abandoned? Yes. BMJ 335:424

    PubMed  Article  Google Scholar 

Download references


The authors thank Dr. Zeno Stanga for his help in translating the original German text of Courvoisier’s Casuistisch-statistische Beiträge zur Patholgie und Chirurgie der Gallenwege.

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Correspondence to Dileep N. Lobo.

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Fitzgerald, J.E.F., White, M.J. & Lobo, D.N. Courvoisier’s Gallbladder: Law or Sign?. World J Surg 33, 886–891 (2009).

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  • Common Bile Duct
  • Obstructive Jaundice
  • Malignant Obstruction
  • Jaundice Patient
  • Gallbladder Volume