Gall-stones and diseases of the bile-ducts . baseis formed by the liver. It was obtained from a manwho died in consequence of the perforation of atyphoid ulcer in the lower part of the ileum. Thecolon and ileum were extensively ulcerated. Fatalperitonitis has been set up in the course of typhoidfever by perforation of a typhoid ulcer in the gall-bladder (Murchison). Cholecystitis associated with gall-stones is oftencomplicated by ulceration of the mucous membrane,and some of the most dangerous consequencesarising from gall-stones are brought about by theulceration ; for it leads to perforation
Gall-stones and diseases of the bile-ducts . baseis formed by the liver. It was obtained from a manwho died in consequence of the perforation of atyphoid ulcer in the lower part of the ileum. Thecolon and ileum were extensively ulcerated. Fatalperitonitis has been set up in the course of typhoidfever by perforation of a typhoid ulcer in the gall-bladder (Murchison). Cholecystitis associated with gall-stones is oftencomplicated by ulceration of the mucous membrane,and some of the most dangerous consequencesarising from gall-stones are brought about by theulceration ; for it leads to perforation of the walls ofthe gall-bladder, and it will involve adjacent visceraand tissues, leading to events which may terminate ina lucky manner for the patients, but, on the otherhand, often places their lives in the greatest peril. (4) Gangrenous cholecystitis. — The destructive CHOLECYSTITIS 29 effects of acute cholecystitis are illustrated by thespecimen Fig. 6; in this instance the whole of themucous membrane was found lying as a slough in. Fig. 6.—The mucous membrane of a gall-bladder which hadcompletely sloughed; it is represented inverted with theminute calculi dotted over it. the gall-bladder. There were two perforations in thewall of the gall-bladder, one opening into the trans-verse colon and the other into the general peritonealcavity. The man was fifty-eight years of age, andhe died in the Middlesex Hospital after an illness 30 DISEASES OF THE BILE-DUCTS of ten days. The pancreas contained several smallabscesses. (5) Membranous cholecystitis.—This term is appliedto an acute and usually calculous cholecystitis inwhich a membrane forms on the inner surface ofthe gall-bladder. This membrane may be presentin patches, or it may be so extensive as to producea complete cast of the gall-bladder. Cases have been reported in which such membraneshave been shed in patches or more or less entire, andtheir passage through the ducts was accompaniedby attacks of pain (biliary colic
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