Courvoisier's law states that in a patient with obstructive jaundice, a palpable non-tender gallbladder suggests malignant obstruction rather than gallstone disease. What is the anatomical/pathological basis for the exception (when stones cause a palpable gallbladder)?

• A Empyema of the gallbladder with inflammatory distension
• B Mucocele or hydrops of the gallbladder due to cystic duct obstruction by a stone without choledocholithiasis ✓
• C Carcinoma of the gallbladder obstructing the cystic duct
• D Mirizzi syndrome causing extrinsic compression of the CBD by a stone in Hartmann's pouch

Explanation

Courvoisier's law applies specifically to obstructive jaundice from CBD obstruction. In chronic gallstone disease, fibrotic scarring of the gallbladder wall prevents distension. However, an exception occurs when a stone obstructs only the cystic duct, causing mucocele (clear mucus accumulation) or hydrops — this produces a palpable, non-tender gallbladder without CBD obstruction (hence no jaundice). Courvoisier's law remains valid for the jaundice scenario, where a palpable GB in the setting of painless jaundice implies malignancy (periampullary carcinoma, cholangiocarcinoma, pancreatic head cancer).

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.