The Courvoisier sign refers to a gallbladder that has become swollen due to the buildup of bile. It is also known as Courvoisier’s law. If you have this condition, your doctor will be able to feel your gallbladder sticking out of your stomach.
Having the Courvoisier sign often suggests you have conditions that need to be treated. Read on to learn more about the Courvoisier sign, what it is, how it’s diagnosed, and how you can treat it.
Symptoms
A lot of the time, you won’t feel abdominal pain if you have the Courvoisier sign.
But you may experience some symptoms, such as:
- Dark urine
- Light stools
- Distension (sticking out) of the gallbladder caused by the buildup of bile
Your gallbladder helps your body process fats by releasing bile into your digestive system. Bile is a digestive liquid produced by your liver.
Having the Courvoisier sign typically means that you have jaundice. This means you may have a yellow tint to your eyes or skin.
The jaundice itself doesn’t usually need to be treated in adults. Some symptoms, such as itching and stomach pain, can be eased with medication.
Causes
The Courvoisier sign is caused by an obstruction or buildup of bile in the bile duct. X-rays of people with the Courvoisier sign show a lump in the head of the pancreas, a bloated bile duct, and an elongated and bloated gallbladder.
The Courvoisier sign was first identified by Ludwig Courvoisier in 1890. At that time, it was believed that people with the Courvoisier sign didn’t typically have gallstones.
With gallstones, fibrosis in the wall from repeated stones keeps the gallbladder wall from distending. Patients with painless jaundice and a distended gallbladder often have a cancerous blockage of the common bile duct. This became known as Courvoisier’s law.
Courvoisier observed that certain tumors in the pancreas or around the ampulla of Vater could make the bladder enlarge and stick out.
Tumors can cause a chronic or long-term rise in pressure, which can make your gallbladder stick out all the time. In contrast, gallstones make your gallbladder stick out some of the time only, due to the fibrosis that forms in the gallbladder wall.
Some patients with the Courvoisier sign have gallbladder stones, which indicates there are exceptions to Courvoisier’s law.
Diagnosis
When Courvoisier sign is seen, certain tests can be done to find out the cause. They may include:
- CT scan
- Blood tests
- Ultrasound to look at the gallbladder, bile duct, and pancreas
- Endoscopic tests to look at the area involved
Having the Courvoisier sign is sometimes a sign of cancer. The enlargement of the gallbladder can be a symptom or precursor to cancer. Among people with cancer of the pancreas, 50% to 70% have painless jaundice and a gallbladder that sticks out.
Treatment
Having the Courvoisier sign doesn’t always mean you have cancer or another underlying condition. In some cases, the cause of the enlarged gallbladder does not have to be treated.
Your doctor will examine you and order tests to determine what is causing the Courvoisier sign. If they determine the blockage is caused by a polyp or benign growth, which is unlikely to be cancerous, you may not need treatment.
If the growth or tumor is cancerous, the doctor will remove it as soon as possible to prevent it from spreading to nearby organs, if it hasn't already.
Your doctor will probably use laparoscopic surgery to look for where the cancer has spread before doing any other type of surgery. Some cancer is resectable, which means it can be removed completely. In this case, your doctor will use laparoscopy to plan the operation to remove the cancer.
But in most cases of gallbladder cancer, your doctor will suggest an extended or radical cholecystectomy. The extent of this surgery depends on how far the cancer has spread. At a minimum, this surgery will remove:
- All of the lymph nodes in the gallbladder region
- About an inch of liver tissue that’s next to the gallbladder
Your doctor may suggest removal of the following if they feel it’s necessary:
- The common bile duct
- Lymph nodes in the pancreas region and around the nearby major blood vessels
- The pancreas
- A bigger section of the liver, ranging from a small section of the liver next to the gallbladder to a whole part of the liver
- The duodenum, which is the section of the small intestine that the bile duct drains into
- Any other organs where the cancer has spread
On the other hand, some cancer is unresectable, which means it won’t be able to be removed completely and has spread too far. In this case, your doctor may suggest palliative surgery. This type of surgery prevents complications and relieves pain caused by symptoms such as blockage of the bile ducts.
An example of palliative surgery for unresectable gallbladder cancer is putting a metal or plastic tube, known as a stent, inside a bile duct with a tumor. This will keep the bile duct open so bile can flow through it.