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. Diseases of the gall-bladder and bile-ducts, including gall-stones . ady loss of flesh. At theoperation the stomach was found firmly adherent to thegall-bladder, and on separating the adhesions a fistulabetween the gall-bladder and stomach was found. The edgesof the ulcer in the stomach were pared, and the openingclosed with two rows of sutures; while the opening in thegall-bladder was utilized to remove the gall-stones throughand afterwards to allow drainage. The patient made anexcellent recovery, and is now in good health. The Middlesex Museum has a specimen of gall-bladderstomach fistula.
. Diseases of the gall-bladder and bile-ducts, including gall-stones . ady loss of flesh. At theoperation the stomach was found firmly adherent to thegall-bladder, and on separating the adhesions a fistulabetween the gall-bladder and stomach was found. The edgesof the ulcer in the stomach were pared, and the openingclosed with two rows of sutures; while the opening in thegall-bladder was utilized to remove the gall-stones throughand afterwards to allow drainage. The patient made anexcellent recovery, and is now in good health. The Middlesex Museum has a specimen of gall-bladderstomach fistula. (No. 1,595.) INFLAMMATORY AFFECTIONS 89 Murchison was of opinion that all vomited gall-stones musthave entered the stomach through a fistula. In one case, Jeaffreson* found such a fistula post-mortem,a gall-stone having been vomited some time before. case, previously referred to, is an example. No. 1,706*, Kings College Museum, is a specimen from acase which died seven to eight weeks after gall-stones were Liver held upby Retractors. Gall-bladder. Fig. 25.—Adhesion of Gall-bladder to Stomach, leading toDilatation of Stomach and Spasmodic Pain. removed from the pleural cavity by Professor Rcse, but nocommunication was found after death between the gall-bladder and pleura. Of the rarer forms—biliary urinary, biliary vaginal, biliarythoracic, biliary pulmonary, biliary pericardial, biliary medi-astinal, biliary pleural, biliary retro-peritoneal, biliary portal,hepato-gastric—we have no experience, and can only refer tocases collected by Courvoisier, Naunyn, Murchison, etc.* British Medical Journal, May 30, 1868. CHAPTER III. INTESTINAL OBSTRUCTION. Intestinal obstruction from gall-stones is such a distinctcomplication of cholelithiasis, calling for special treatment,that it will not be beyond our province to consider it; andas the chief variety of obstruction is necessarily associatedwith fistula, it seems convenient to consider it here. So much has been
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