. Annals of surgery. m posterior abdominal B, line of section. it may be crushed when small and soft, as in Case I, after whichthe gall-bladder must be sutured to the parietes to allow of theescape of the fragments; or if the stone is hard and inaccessible, the ON GALL-STONES. 203 gall-bladder should be excised, the stone removed, and the cysticduct ligatured. When a stone is impacted in the common duct, it dependson what part of the duct it is lodged in whether the finding of itduring the operation is easy or difficult, and its removal safe orcomplicated. The stone may be, and by f
. Annals of surgery. m posterior abdominal B, line of section. it may be crushed when small and soft, as in Case I, after whichthe gall-bladder must be sutured to the parietes to allow of theescape of the fragments; or if the stone is hard and inaccessible, the ON GALL-STONES. 203 gall-bladder should be excised, the stone removed, and the cysticduct ligatured. When a stone is impacted in the common duct, it dependson what part of the duct it is lodged in whether the finding of itduring the operation is easy or difficult, and its removal safe orcomplicated. The stone may be, and by far most frequently is, lodged inthat portion of the common bile-duct before it dips under theduodenum and head of the pancreas, when it can be grasped andremoved by a direct incision after exposure of the portion of ductin which it is lying, the separation of (often troublesome) adhesionsbeing the chief difficulty, or it may be lodged, as in Case IV, inthe end of the duct (ampulla of Vater), where it is entirely cov-. FiG. 8.—Extracting scoop for common bile-duct. ered up by the head of the pancreas, and interferes with the flowfrom the pancreatic duct. The inability to feel the stone and theinduration of the head of the pancreas in such a case may leadthe operator, as I have the misfortune to know, to believe that heis dealing with a pancreatic tumor. The diagnosis can only beconfirmed and the stone with difficulty removed by opening thedilated duct at a convenient spot and introducing the finger andextracting instruments down to the stone through this opening,as in Case IV. After touching the stone, the difficulties of extracting itthrough the incision in the duct may be insurmountable, thoughMessrs. Down Bros, have made at my suggestion an extractingscoop (see Fig. 8), which must make such difficulty rare. 204 RUTHERFORD MORIS ON. In such a case I would suggest that an opening should bemade in the convexity of the second part of the duodenum,through which a finger or probe
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Keywords: ., bookcentury1800, bookdecade1880, booksubjectsurgery, bookyear1885
