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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    crumbling remains of a number of small faceted gall-stones. It appeared, indeed, that the acuteness of the inflammation had broken up a multitude of faceted gall-stones into this mud. If the moisture were absorbed from this mass and it consoli- dated with the formation of minute crystals of cholesterin, it would produce just such a large friable amorphous calculus as in this case. I must admit, however, that I found no trace of partially eroded calculi on section; and of course this theory of the origin of large gall-stones would not apply to those which are lamellated. The liver, gall-bladder, bile ducts, and duodenum were dis- sected as in Case II, and this specimen was shown with the other at the meeting of the Pathological Society. The Duodenum was curiously twisted, and indeed inverted. The stomach, pylorus, and first part of the duodenum had appar- ently been forced downward, so that the second part ran up instead of down, and the duodenojejunal flexure and its suspen- sory ligament (muscle of Treitz) were on a much higher level than the pylorus and first part of the duodenum (Fig. 8). This was probably produced by tight lacing in youth, and the forma- tion of the gall-stones may have been due to this cause, as has been urged by Mr. Arthur Kieth, who regards gall-stones as a part of what he has called corset disease. The first part of the duodenum formed practically the major part of the posterior wall of the gall-bladder, and here a large ragged fistula existed between them. The Gall-bladder was not greatly enlarged, but its walls were thick, ulcerated, and adherent to the duodenum behind as described. It passed by a funnel-shaped neck into a dilated cystic duct, and this joined an equally dilated hepatic duct. The Common duct when flattened out was one-half inch in diameter and somewhat thickened. About an inch below its origin a small elongated stone the size of a small bean was im- pacted. No doubt it was the passage of this stone which caused the onset of the symptoms two months before death with jaun- dice. When this jaundice subsided (for the patient was not more than tinged when admitted to the hospital), it was probably owing to the escape of bile by way of the gall-bladder around the cal- culus and through the fistula. It also seems probable that this stream of bile ultimately loosened the stone and led to its expul-