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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    valve in Case V. This is a rare occurrence, for Treves states that he could find no case in which the calculus was felt before operation. In the diagnosis of this condition it is usual to make a great point of previous biliary symptoms, but when we remember that the large stones capable of causing intestinal obstruction are usually single, and that they do not, as a rule, pass down the duct, we perceive at once that jaundice and true biliary colic will generally be absent, and that the symptoms will be limited to more or less obscure pain in the region of the liver. In Case VI, however, the obstruction was due to the largest of the three stones; moreover the presence of several facets indicated further calculi, and there was accordingly a clear history of attacks of biliary colic and jaundice. In my second case there was definite hepatic pain, but not jaundice or colic. In my third case the attack of jaundice which heralded the obstruction was caused by the gall-stone found in the com- mon duct. The mortality after operation for gall-stone obstruction is apparently very high. Waring12 quotes the following- figures: Lobstein, thirty-one cases of operation; mortality, 61.3 per cent. Courvoisier, 125 cases of operation; mortality, 44 per cent. Schuller, eighty-two cases of operation; mor- tality, 56 per cent. Jonathan Hutchinson, Sen., mortality, 50 per cent. Mr. Eve13 collected twenty cases of gall-stone obstruction when he reported his own case. Of these fifteen were sub- mitted to operation, and six died, that is to say, 40 per cent. Of the series of eight cases reported above, seven were oper- ated on, and of these four died, making a mortality of 57.12 per cent. Of the four that died, one aged sixty-three had been obstructed five days; one aged seventy-three had been obstructed five days; another aged fifty had been obstructed ten days, and the last, aged sixty-eight, five days. Tillmann states that recent results are much more favor- able, and he quotes Korte as having saved four out of five con- secutive cases. Treatment.—So seldom has it been possible to state before