Significance of hyperbilirubinemia in acute cholecystitis

The incidence and significant of hyperbilirubinemia were examined in 110 consecutive patients who entered the hospital with signs and symptoms of acute cholecystitis and underwent laparotomy. Thirty-two or 29 per cent were found to have abnormally elevated serum bilirubin levels on admission. Surgical or roentgenographic examination of the common duct, or both, in 19 of these patients disclosed stones in 13. Serum levels of bilirubin averaged 6.1 milligrams per cent in those with stones and 2.7 milligrams per cent in the others. In the remaining 13 patients, the common duct was not examined, but elevated bilirubin levels, averaging 2.6 milligrams per cent, quickly returned to normal values, and the subsequent course was uneventful. Hyperbilirubinemia significantly increases the likelihood of finding common duct stones in patients with acute cholecystitis, although it also occurs frequently in patients with acute cholecystitis without common duct stones. The underlying mechanism in the latter situation is still oscure but may depend on an alteration in the normal impermeability of epithelium of the gallbladder to conjugated bilirubin.