[The five syndromes of biliary obstruction]

Clinical description of biliary diseases are slightly over a century old. At the end of last century and beginning of the present one, laws were established and clinical syndromes were described; these are still valid at present. Some modern techniques such as ultrasonography confirmed the importance of the Courvoisier-Terrier law. The first syndromatic description was made by two clinicians from Lyon, Bard and Pic, based on autopsy confirmation of clinical features. This paper analyses those rules and exceptions to Courvoisier-Terrier law. Research carried out by Pablo Marizzi, the Argentine surgeon who introduced operatory cholangiography is also analyzed. By means of this technique he was able to study patients better, transforming biliary surgery into a procedure with scientific basis, thanks to imagenological data. The sphincter described by this author turned out to be a radiological artifact due to the use of oily contrast media. Finally the right and left hydrohepatosis syndromes described by Cattell and Braasch in the 1960s are discussed. In 1971 we pointed out our disagreement over jaundice in left hydrohepatosis.