Clinical significance of white bile in the biliary tree.

'White bile' is a clear, colourless, watery fluid found occasionally in the biliary tree proximal to an extrahepatic biliary obstruction. Thus it is neither white nor bilious; and it is not viscid and opaque like the fluid found in the obstructed gall bladder. With the exception of the paper by Judd and Lyons (1923) previous reports on white bile dealt either with a single patient (Edington and McCallum, 1930; Lake, 1934; Flint, 1937; Griffiths, Haber, Rees, and Smith, 1963; Bouchier and Cooperband, 1965), or with several patients (Aronsohn, 1936; Hawthorne and Sterling, 1955), or with experiments carried oult in animals (Rous and McMaster, 1921; McMaster, Broun, and Rous, 1923; Cameron and Oakley, 1932; Aronsohn, 1935; Haber and Rees, 1963). These reports contain certain generalizations about the possible clinical significance of white bile. It could be assumed that it is found most frequently in those obstructions due to stone (Flint, 1937; Hawthorne and Sterling, 1955) or either stone or stricture (Judd and Lyons, 1923); that it will be found only when the gall bladder is either distal to the obstruction or when it is not functioning (Rous and McMaster, 1921; McMaster et al, 1923; Judd and Lyons, 1923; Lake, 1934; Griffith et al, 1963); that it occurs only when there is infection in the fluid (Aronsohn, 1935 and 1936); that total obstruction is always present (Aronsohn, 1936); and that it signifies severe liver damage and a grave immediate prognosis (Flint, 1937). In this paper we report the findings in nine patients admitted to Prince Henry Hospital each with obstructive jaundice and each with clear, colourless, watery fluid in the biliary tree. The findings in these patients have been examined to appraise the clinical significance of finding white bile at operation.