Intestinal obstruction due to gall-stones : report of three cases, with summary of five more cases from the records of the London Hospital, 1893-1901 / by H.L. Barnard.

  • Barnard, Harold Leslie, 1868-1908.
Date:
[1902]
Catalogue details

Licence: In copyright

Credit: Intestinal obstruction due to gall-stones : report of three cases, with summary of five more cases from the records of the London Hospital, 1893-1901 / by H.L. Barnard. 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.

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    duodenum was normal in position and structure. The third and fourth parts of the duodenum showed no pathological changes. 2. The Gall-Bladder and Calculi.—The gall-bladder was found divided into four loculi or compartments, separated from one another by dense fibrous septa, and communicating by orifices of not more than a quarter of an inch in diameter. (1) The first at the fundus contained twelve small calculi, the smallest of which was the size of a tare, and the largest that of a pea. (2) The second compartment, about the middle of the gall- bladder, contained a solitary large smooth calculus faceted at both ends, and only a little smaller than that taken from the ileum. It weighed ninety-seven grains when dry. (3) The third loculus was near the neck of the gall-bladder, and it was this one which communicated with the duodenum. It was for the most part empty, so that the calculus taken from the intestine was reintroduced with ease, but in one corner a small calculus the size of a pea was found. (4) The fourth and last compartment was at the very en- trance to the cystic duct. It was not larger than a pea, and com- municated by only a pin-hole with the third loculus. It was completely filled by a round tuberculated and pale-colored calcu- lus. The cystic duct had apparently been obliterated by this stone, for no probe could be passed either from this compartment into the common duct or in the reverse direction. Perhaps this stone was impacted in the cystic duct, and had led by its complete obliteration to the necessity of a fistula into the duodenum. 3. The Hepatic, Cystic, and Common Ducts.—The hepatic and common bile ducts were very little, if at all, dilated. The common duct at its widest point would have just taken a medium- sized pencil. Its orifice into the duodenum was not dilated. The cystic duct, as has already been said, was obliterated, and existed only as a fibrous cord connecting the common bile duct with the neck of the gall-bladder. The common bile duct was clearly demonstrated to its entrance into the duodenum, and certainly the large stone removed from the ileum did not pass this way. The pancreatic duct was in no way abnormal. Case III.—I. P., a German woman, aged sixty-eight years, was admitted on the afternoon of September 11, 1901. She was in so collapsed a condition and spoke so little English that no