Seventy consecutive gallbladders removed at surgery were examined radiologically and pathologically. Fifteen (21%) of the operative specimens showed naked-eye changes of adenomyomatosis. The main conclusions drawn from this study are that this abnormality is present in a much higher proportion of gallbladders removed at surgery than is generally realised, and that the pathogenesis is primarily an abnormality of muscle contractions, with a strong similarity to diverticular disease of the colon. Diverticular disease of the gallbladder might well be the most appropriate name for this condition. The results of a post-operative clinical assessment of patients with diverticular disease are also presented. But this represents a small number of patients and larger, perhaps multicentre, surveys would be required in order to assess the clinical significance of this interesting abnormality.
The colon is the portion of the alimentary tract that has generated least interest among investigators and although the last decade has seen new methods applied to physiological problems in the large bowel, the detailed anatomy of the muscular layer remains a neglected subject, with the successfully located articles which consider this matter very few in number.Each of us undertook an independent investigation and in this field of pattern recognition where observer error can be very gross, our conclusions have been surprisingly similar, so much so that a common set of photographs serves to illustrate the results.
MATERIALS AND METHODSAn independent investigation was carried out by each of us using similar methods but on different material.In the first series (J.L.P.), postmortem specimens were used and included only colons removed from patients who had died of conditions unrelated to colonic disease. The colons were obtained within 12 to 24 hours of death, and were left in 10% formol saline for not less than 24 hours or in Carnoy's fluid for a few hours. Some were fixed in distension and others undistended. Portions from the different regions of the colon, some including a taenia and others from the intertaenial wall, were examined. Small pieces (about 5 x 5 cm) were removed and the serosa, mucosa, and submucosa dissected away. More than 30 specimens were examined. Portions of the colonic wall (12 specimens) were also treated enzymatically before dissection using Camoy-fixed material, by incubation at 37°C for 16 hours in a 1 mg/ml collagenase solution in normal saline. This technique removes the connective tissue from between the fasciculi, which were thus rendered looser and easier to follow.
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