The route of infection to the gallbladder has been studied by many observers, and three possible sources of infection have long been recognized as likely. The well known fact that the blood in bacteremia passes many organisms into the bile has been used by many observers as an argument in favor of the biliary origin of cholecystitis. Others are inclined to favor the hematogenous theory, largely on account of the experiments of Rosenow1 on the elective localization of certain strains of streptococci. More recently, the studies of Graham2 and his co-workers on the absorption of dyes or particulate matter from the region of the gallbladder has brought into prominence the possibility of a carrying of bacteria in the lymph to the gallbladder from the adjacent viscera, especially the liver.
Recent studies on the bacterial flora of the normal liver have again suggested the importance of the latter route
ANDREWS E, HRDINA L. HEPATOGENOUS CHOLECYSTITIS. Arch Surg. 1931;23(2):201–214. doi:10.1001/archsurg.1931.01160080029004
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