Cholecystotomy : with a report of two new cases, a table of all the hitherto reported cases, and remarks / by J.H. Musser and W.W. Keen.
- John Herr Musser
- Date:
- [1884]
Licence: Public Domain Mark
Credit: Cholecystotomy : with a report of two new cases, a table of all the hitherto reported cases, and remarks / by J.H. Musser and W.W. Keen. 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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![of the duct/ 111 his first Ccase, Tait was compelled to extract a stone piecemeal, by a careful and diffi- cult operation. In maiij^ if not most of the opera- tions, other stones not discovered at the operation have escaped subsequently. This shows the wisdom of the last step in the operation, viz., the establish- ment of a biliary fistula by stitching the edges of the opening in the gall-bladder to that in the abdominal wall. A large fenestrated drainage tube should be inserted and the whole covered with antiseptic dress- ings. For the first few dressings, when the discharge will be large, some carbolized sponges may be also placed nnder the dressings to absorb this discharge. The fistula will ordmarily heal within a few weeks at least—in marked contrast to the fistulas following nature's method of adhesion and external discharge. In these the opening is generally insufficient to per- mit the escape of the gall-stones, and the fistula with all its dangers may continue open even so long as fourteen years. The collapsing gall-bladder might be supposed to drag on the abdominal wall by its adhesions, but no such trouble has been reported. For a considerable time a terwards it might be ' Tait (British Med. Journ., July 12, 1884), in this case of stone in the common duct, states that he did crush the stone (size of a cherry) by two strokes of the forceps. After it was broken the fragments dispersed, and they have given no trouble at all since the operation, only a very small quantity of mucous fluid faintly tinged with bile has come through the fistula, and the yjatient's motions are normal in color. He intends to close the fistula in a few days. [Should not the fragments have been removed, unless indeed they escaped into the intestine (the word dispersed does not seem entirely clear), lest they prove the nuclei for formation of future stones? K.]](https://iiif.wellcomecollection.org/image/b2229546x_0059.jp2/full/800%2C/0/default.jpg)
