Gall-stones and diseases of the bile-ducts . pied the same position. On the fifth day it wasexpelled through the anus. A woman, aged forty-six years, was admitted tothe Middlesex Hospital in 1856 with signs of acuteintestinal obstruction. She died two days afteradmission, and at the post-mortem examination agall-stone was found completely blocking the ileum(Fig. 33). The gall-stone was perfectly cylindrical/and measured nearly 4 in. in circumference and indiameter 1\ in. : the dilated and distended intestineabove the obstruction contained ten small, angular,biliary calculi about half the size
Gall-stones and diseases of the bile-ducts . pied the same position. On the fifth day it wasexpelled through the anus. A woman, aged forty-six years, was admitted tothe Middlesex Hospital in 1856 with signs of acuteintestinal obstruction. She died two days afteradmission, and at the post-mortem examination agall-stone was found completely blocking the ileum(Fig. 33). The gall-stone was perfectly cylindrical/and measured nearly 4 in. in circumference and indiameter 1\ in. : the dilated and distended intestineabove the obstruction contained ten small, angular,biliary calculi about half the size of hazel-nuts. The gall-bladder, the adjacent part of the liver,with the pyloric section of the stomach and duodenum,are represented in Fig. 34. The gall-bladder with 100 DISEASES OF THE BILE-DUCTS its thickened walls is intimately united with theduodenum at the junction of the first and secondportion, and at this part its cavity communicatesdirectly with the lumen of the duodenum, and thisopening indicates the path followed by the calculi,. Fig. 33.—Obturation of the ileum by a gall-stone (Museumof the Middlesex Hospital). the largest of which obstructed the ileum. The casewas described in 1857 by Yan der Byl. The partshave been preserved fifty years in spirits of wine,but on careful examination of the ducts I think thecystic duct is obliterated as a result of chroniccalculous cholangitis, which explains also, thethickened condition of the gall-bladder and thecommon duct. No very careful attempts have beenmade to determine which is the usual spot in the GALL-STONE ILEUS 101 duodenum for gall-stones to perforate it, but judgingfrom two other examples upon which I have had tooperate for a cholecysto-duodenal fistula, it seems to
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