Clinical significance of white bile in the biliary tree.

Presence of white bile in malignant biliary obstruction is associated with poor prognosis: personal preliminary observations

“…A contrary opinion was expressed in 1969 by Elmslie [3] that WB did not reflect impairment of liver function and was not associated with a worse prognosis.…”

“…However, it was demonstrated that obstruction distal to a normal gallbladder can also cause the formation of WB [3].…”

“…Thus, surgeons were the first to recognize the phenomenon of WB and anecdotally associated it with a poor prognosis [5,6]. Subsequently, scattered and contradictory reports regarding the significance of WB appeared [1,3,7]. However, there was no systematic study of the cause and effect of WB, nor of its prognostic implications.…”

Three Cases of Canine Bile Peritonitis with Mucinous Material in Abdominal Fluid as the Prominent Cytologic Finding

“…11 Mucosubstances similar to the mucinous material observed in abdominal fluid from these dogs has been described in human patients secondary to extrahepatic biliary obstruction and is termed "white bile." [11][12][13][14][15][16] White bile is a colorless fluid found in bile ducts and the gallbladder and is devoid of all bile constituents except a "mucin-like"substance. 11,16 However, the term white bile is misleading in view of the fact that, by definition, bile is a yellowish brown or green fluid secreted by the liver.…”

“…This process may explain the presence of bilirubin‐free mucosubstances within the dilated bile ducts of dog 2. Although the surface epithelium of the gallbladder normally contains a low number of goblet cells and mucous glands, their number is increased in response to inflammation and cholelithiasis 14,15 . Under these conditions, the mucus and hexosamine content of the gallbladder fluid can increase.…”