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

Abstract

White bile is largely devoid of bilirubin and bile acids. The presence of white bile was associated with significantly worse survival in patients with malignant biliary obstruction.

Dogs with biliary rupture based on ultrasound findings may have normal total serum bilirubin values

“…Not previously reported, half of our cases with mucinous material had concurrent bile pigment present. This contradicts the definition of white bile in human literature, as by definition it is the lack of bile pigments and is colorless in appearance 11–13 . That our patients had the presence of both bile pigments and the mucinous material could be due to a transitional period where bile pigments are still present, but removal of bile pigments and production of mucinous material has started.…”

“…Instead basophilic mucinous material forming clumps in the effusion, similar to white bile found in humans, was reported 10 . In humans, white bile is defined as a colorless fluid that is devoid of bilirubin and bile acids found in ruptured biliary tracts and is associated with malignant obstruction of the biliary tract 11–14 . Although the underlying formation of white bile is not well understood, one study in dogs found that white bile formed when both the common bile duct and the cystic duct were ligated as compared to the formation of bile pigments that formed when only the common bile duct was ligated, leaving the gallbladder in communication with the rest of the biliary tree 15 .…”

“…Typical bile peritonitis is described as a greenish‐yellow fluid with elevated bilirubin levels and bile pigments 10–12 . A series of three dogs having biliary tract rupture and effusion lacking bile pigments has been described 10 .…”

Effect of Prolactin on Excretory Function of the Liver during the Induction and Relief of Cholestasis in Female Rats

“…This process results in mechanical obstruction of bile fl ow. The appearance of "white bile" can be related to both increased degradation of bilirubin with the bile and changes in the directionality of bilirubin transport [7]. This work was supported by the Russian Foundation for Basic Research (grant No.…”

White Bile in Malignant Biliary Obstruction: A Poor Prognostic Marker

“…Patients with white bile have a predisposition to infection due to ineffective drainage and reduced antimicrobial activity. Furthermore, the finding of white bile in malignant jaundice has been associated with shorter survival than that in patients with green bile [ 2 , 3 ].…”