Operative surgery of the gall tracts with original report of twenty successful cholecystenterostomies by means of the anastomosis button . of the nonadherentgall bladder. In the other seventeen cases the puncture was purelyexplorative. Puncture of the gall bladder from the surface of theabdomen without incision was suggested by G. Harley for the pur- pose of sounding for gallstones. He pronounced it an easy andsafe method for sounding for impacted stones, but his patient diedtwenty-four hours after the operation of enteritis and operation is to be condemned first, because ther
Operative surgery of the gall tracts with original report of twenty successful cholecystenterostomies by means of the anastomosis button . of the nonadherentgall bladder. In the other seventeen cases the puncture was purelyexplorative. Puncture of the gall bladder from the surface of theabdomen without incision was suggested by G. Harley for the pur- pose of sounding for gallstones. He pronounced it an easy andsafe method for sounding for impacted stones, but his patient diedtwenty-four hours after the operation of enteritis and operation is to be condemned first, because there is greatdoubt that a diagnosis can be made with a needle, even if a stoneis present. Second, a needle puncture of the gall bladder is danger-ous because the opening remains patulous, as I have frequently«een following aspiration preparatory to insertion of the button,from an absence or very limited contractile power of the tissues ofthe wall of the gall bladder and from tension by the bile pressurewithin. Third, if the contents of the gall bladder in the case shouldbe septic, we would have as a result a septic peritonitis. Cour-. FiGURE 1.—Drainage tube button illustrating half of button threaded for intro-duction into gall bladder. voisier says, that a surgeon should even hesitate to aspirate a casewhere the diagnosis of gall bladder lesions was even suspicious,and never except where no other means of diagnosis is left, a lap-arotomy being a much more rational and safe method. II. Incision of the Gall Bladder Without Further Operative Pro-icedure.—This operation is performed for and should be limited tocases where the gall bladder, on account of the gangrene of itswall or extensive adhensions all around it render it impossible toeither suture it to the abdominal wall or approximate it to any por-tion of the intestinal tract, and where it is compulsory to securedrainage of the bladder or to use the bladder as a canal to allowthe escape of bile in obstructive jaundice, th
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Keywords: ., bookcentury1800, bookdecade1890, booksubjectgallbla, bookyear1894
