Operative surgery of the gall tracts : with original report of twenty successful cholecystenterostomies by means of the anastomosis button / by John B. Murphy.

  • Murphy, J. B. (John Benjamin), 1857-1916.
Date:
1894
Catalogue details

Licence: Public Domain Mark

Credit: Operative surgery of the gall tracts : with original report of twenty successful cholecystenterostomies by means of the anastomosis button / by John B. Murphy. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    26/54 (page 24)
    ing directly downward. The gall bladder was found distended, nonadherent, and contained a large number of small calculi. Two calculi were found in ductus choledochus and allowed to remain. Duodenum and gall bladder were both drawn into the wound; an in- cision was made in the duodenum and half of the button inserted. A running thread was put in the gall bladder, an incision made, and the other half of the button inserted. The gallstones were not removed. There was considerable escape of bile, as gall bladder was not aspirated before putting in the button. The button was then pressed together without any difficulty, and the mass dropped into the abdominal cavity. Time from the opening of the perito- neum until the closing of same, eleven minutes. After the opera- tion the patient showed no unpleasant s}'mptoms ; temperature at no time exceeded 100° F., and in fourteen days fromf the operation | she was allowed to walk about the ward. The jaundice rapidly i disappeared, and three weeks after the operation there was no trace of bile in the urine. The patient was of a very hysterical ' temperament after her mental condition improved ; she noticed i that she was an object of observation and became so erratic that j we could not control her at the hospital, and were compelled to ] discharge her five weeks after the operation. Up to that time she < stated that she had “not passed the button.” She was apparently | well in every particular. The button used in this case was very | imperfect compared with the improved one now used. j October 28, 1892. Patient was examined by Dr. H. R. | Wittwer. He found the jaundice had not returned; there was no | bile in the urine, and the patient was in excellent health. He could not ascertain whether she had passed the button or not. In December, 1892, this patient began to suffer from pain in the right side and temperature which continued to January, I 1893. She was in one of the hospitals in this city. An explor- j atory operation was made over the site of the former operation, j a contracted gall bladder was found firml)’ and perfectly united ^ to the duodenum. Subsequently the cause of the temperature was found to be an abscess of the lung, npt an empj’ema, ^ which was drained, and the temperature at once disappeared. At ^ no time since the first operation has the patient been jaundiced, y nor has there been bile in the urine. i. Case II. The following case was referred to me by Dr. Hoelscher, who with Drs. Wiener and Lee, assisted me in the operation. Mrs. B , age thirty-eight, widow, three children. .