“White bile” (WB) (Figure) is a clear sero-mucous secretion of gallbladder that is largely devoid of bilirubin and bile salts. It arises from glycoproteins that are normally secreted by the mucosal glands of the gallbladder infundibulum and neck, and is thought to shield the gallbladder wall from the lytic action of bile.

WB is observed in “hydrops” of gallbladder and is caused by absorption of bile by the gallbladder wall in the setting of persistent cystic duct obstruction¹. It is commonly held that in persistent cystic duct obstruction, bile in the gallbladder is eventually absorbed into the lymphatics and blood vessels but that the gallbladder epithelium continues to produce clear sero-mucous secretions. In this setting, dilatation, perforation, and atrophy of the gallbladder lumen may also occur^1-3.  Early cholecystostomy tube placement or cholecystectomy is often indicated^1,3.

Common etiologies of persistent cystic duct blockage in adults include, stone impaction, cystic duct stenosis, tumors/polyps, and parasites (eg, ascariasis).

Figure: “White bile” drainage from a cholecystostomy drain of a patient with cholecystitis and persistent cystic duct blockage due to stones. The drainage was completely clear with mucous characteristics. 

Reference:

1. Schwartz, Seymour I, Brunicardi, F. Charles., eds. Schwartz’s Principles Of Surgery. New York : McGraw-Hill Medical, 2011.
2. Ahmed A, Cheung RC, Keeffe EB. Management of gallstones and their complications. Am Fam Physician 2000; 61, 1673-1680.
3. Lawrence S. Friedman, Mark Feldman. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease 10^th Edition. Philadelphia, PA: Elsevier, 2015.

Contributed by Alireza Sameie, Medical Student, Harvard Medical School