Stratification of Bile

Abstract

Summary The types of stratification seen in the cholecystogram together with the edge‐ring are demonstrated and the literature reviewed. Stratification which can be determined radio‐graphically occurs in the majority of normal people after an all‐night fast and before the first meal of the day. It disappears shortly afterwards. It is a normal finding and its transient nature would make it unlikely to be a gallstone precursor. There remain a few cases where layering occurs with stasis where excessive inspissation and stone formation would be a possibility. The author wishes to acknowledge the kindness of Dr. Karla Plehwe in translating the German texts. Without this assistance this paper could not have been written.

Stratification in the gallbladder during intravenous cholangiography

“…In these positions the stratification phenomenon is most dramatically portrayed with the use of a horizontal x-ray beam [2,9]. The sequence of layering patterns which we have observed is diagramatically represented in Figure 4.…”

“…This opaque edge ring is produced as dilute contrast-laden bile enters through the cystic duct, distending the gallbladder to accommodate the increased volume, and then dissects along the path of least resistance between the gallbladder wall and the nonopacified, inspissated bile in the center. This creates a picture which is too often misinterpreted as an opacified gallbladder containing a large, solitary calculus [2,5,6,8,9]. Progressively over the next 30 minutes, the opacified bile streams through channels in the contrast-free bile, producing a mottled appearance which may then be mistaken for multiple smaller gallstones (Fig.…”

“…Layering may occasionally be seen during oral cholecystography as well as during intravenous cholangiography. It is independent of the type of contrast agent being used and has been observed after administration of iodipamide meglumine (Cholografin, Biligrafin) [2-6, 8, 9], iopanoic acid (Telepaque) [1,9], and ipodate sodium (Oragrafin).…”

“…Approximately 30 minutes after injection of the contrast agent, films may show a dense rim of contrast around the periphery of an otherwise radiolucent gallbladder [2,5,6,8,9]. This opaque edge ring is produced as dilute contrast-laden bile enters through the cystic duct, distending the gallbladder to accommodate the increased volume, and then dissects along the path of least resistance between the gallbladder wall and the nonopacified, inspissated bile in the center.…”

“…In the past there were divergent views on the significance of stratification, some regarding it as a situation predisposing to the formation of gallstones and others regarding it as a normal phenomenon. It is now universally accepted that transient layering of contrast is a normal finding resulting from normal gallbladder function [2,3,5,8,9].…”