CASE HISTORY

The patient was admitted as an emergency complaining of acute pain just under the right costal margin of two days duration. The pain radiated through to the back and was accompanied by repeated vomiting. On examination she was obese with a sallow complexion but no actual jaundice. There was marked tenderness over the gall-bladder and some rigidity. Murphy's sign was positive. The patient was treated expectantly and a cholecystography was performed. This showed an enlarged gall-bladder containing multiple stones. After 33 days the patient's general condition improved considerably and a cholecystectomy was undertaken. The post-operative recovery was satisfactory.

PATHOLOGY

The gall-bladder has been mounted whole, except for a window in the front to expose the stones. Its lumen is filled with large numbers of facetted, mixed cholesterol stones. These vary in size from one large one at the fundus down to minute ones towards the upper end. There is one irregular stone lying at the beginning of the cystic duct. Externally, the gall-bladder is congested and its wall is rather thickened.