. Diseases of the gall-bladder and bile-ducts, including gall-stones . — LEVEL OFSEPTUM. Fig. 4.—Bifid Gall-bladder from a Sheep.(Leeds Museum.) The common bile-duct has recently received much atten-tion at the hands of several observers, and the papers byM. le Dr. Quenu in the Revue de Chirurgie for 1895, and byDr. Fenger in the American Journal of Medical Science forFebruary and March, 1896, are both of great practicalutility. The former gives a number of exact measurements,and describes a small vessel, a branch of the pancreatico-duodenal artery, as also some branches of the portal veinand
. Diseases of the gall-bladder and bile-ducts, including gall-stones . — LEVEL OFSEPTUM. Fig. 4.—Bifid Gall-bladder from a Sheep.(Leeds Museum.) The common bile-duct has recently received much atten-tion at the hands of several observers, and the papers byM. le Dr. Quenu in the Revue de Chirurgie for 1895, and byDr. Fenger in the American Journal of Medical Science forFebruary and March, 1896, are both of great practicalutility. The former gives a number of exact measurements,and describes a small vessel, a branch of the pancreatico-duodenal artery, as also some branches of the portal veinand hepatic artery crossing over the duct, which might beseriously in the way in the operation of Fenger also shows how the portal vein, gradually wind-ing round the common duct, comes to be placed on the ANATOMICAL CONSIDERATIONS 19 outer side of the upper third, even overlapping the front ofit and the termination of the cystic duct, thus apparentlydemonstrating that the middle portion of the ductus com-. Fig. 5.—Field of Operation. Diagram to show Relations ofCommon Bile-duct. (After Fenger.) Wound through abdominal wall; 2, parietal peritoneum sutured to skin ;3, right lobe of liver, lower surface ; 4, quadrate lobe of liver; 5, suspensory-ligament of liver; 6, gall-bladder; 7, cystic duct; 8, hepatic duct; 9, commonduct; 10, branch of hepatic duct to lobus Spigelii; 11, trunk of vena porta;12, branches of vena porta to right lobe; 13, branches of vena porta to lobusSpigelii; 14, small branch of vena porta in hepatico-duodenal ligament;15, hepatic artery; 16, branches of hepatic artery to hepatico-duodenalligament; 17, lymph-glands in hepatico-duodenal ligament; 18, duodenum ;19, entrance to foramen of Winslow; 20, hepatico-colic ligament; 21, trans-verse colon. munis, and the upper two-thirds of the cystic duct, are theonly convenient situations for choledochotomy. Perhapsthe diagram will enable one to appreciate these points moreclearly. 2—2 2o DISEA
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