Courvoisier’s sign (or law) describes an enlarged, palpable gallbladder in patients with obstructive jaundice caused by tumors of the biliary tree or by pancreatic head tumors. This kind of biliary obstruction evolves slowly. The gallbladder will be dilated, with a thin wall; it is not tender to the touch By contrast, acute cholecystitis due to obstruction by stone(s) is a quick process that causes a dilated gallbladder that is tender to the touch (Murphy's sign). The inflammation of chronic cholelithiasis results in a shrunken, fibrotic gallbladder.
Courvoisier’s sign can be found in patients with:
- biliary tumor (cholangiocarcinoma);
- periampullary carcinoma (adenocarcinoma of Vater papila or duodenum);
- pancreatic head cancer;
- lymph node metastasis in the porta hepatis