Gall-stones and diseases of the bile-ducts . fiVTT£/?WofcjfiA Fig. 24.—A solitary gall-stone in a contracted gall-bladder(Museum of the Royal College of Surgeons). have seen an example of this in a thin, emaciated oldwoman. When a gall-bladder contains two large calculiand contracts upon them it will assume an hour-glassshape, and if it be bisected the two distended por-tions will be found separated by a perforated 6Q DISEASES OF THE BILE-DUCTS diaphragm. Bilocular gall-bladders are common,and occasionally, when containing several stones offair size each, may be lodged in a recess and pro-. Fi
Gall-stones and diseases of the bile-ducts . fiVTT£/?WofcjfiA Fig. 24.—A solitary gall-stone in a contracted gall-bladder(Museum of the Royal College of Surgeons). have seen an example of this in a thin, emaciated oldwoman. When a gall-bladder contains two large calculiand contracts upon them it will assume an hour-glassshape, and if it be bisected the two distended por-tions will be found separated by a perforated 6Q DISEASES OF THE BILE-DUCTS diaphragm. Bilocular gall-bladders are common,and occasionally, when containing several stones offair size each, may be lodged in a recess and pro-. Fig. 25.—A gall-bladder contracted on a group of calculi ofirregular shapes and sizes. duce a multilocular arrangement. Naunyn describesthis process as encapsulation, and it indicates thata gall-bladder loculated in this way has been theseat of chronic cholecystitis. A careful distinction must be made between gall- DIVERTICULA 07 stones encapsuled as a result of contraction changesin the gall-bladder and those lodged in a diverti-culum. Gall-stones in diverticula.—It has been pointed outthat gall-stones lead to ulceration of the gall-bladder,which may end in perforation of its walls with ex-trusion of the calculi into the peritoneal cavity orinto an adjacent viscus. In some cases, however,the mucous membrane will be ulcerated through, butnot the muscular coat, and the stone may come tolie in a sacculus between the mucous and muscularcoats, and in course of time the orifice of communi-cation between the sacculus or diverticulum maybecome very narrow, or even obliterated. Diver-ticu
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Keywords: ., bookcentury1900, bookdecade1900, bookpublishernewyorkwilliamwood
