. Diseases of the gall-bladder and bile-ducts, including gall-stones . he cystic duct. Situated atthe junction of the cystic, hepatic, and common bile-ducts,was a growth about the size of a filbert, which was found,when the ducts were opened, to completely occlude them(see Fig. 41). There were no adhesions in the neighbourhood, nor werethere any secondary growths to be found. The stomachshowed no evidences of ulceration, but there were slightsigns of cirrhosis of the liver. There was no peritonitis. Cancer of the ampulla of Vater was probably first described 10—2 148 DISEASES OF THE GALL-BLADD
. Diseases of the gall-bladder and bile-ducts, including gall-stones . he cystic duct. Situated atthe junction of the cystic, hepatic, and common bile-ducts,was a growth about the size of a filbert, which was found,when the ducts were opened, to completely occlude them(see Fig. 41). There were no adhesions in the neighbourhood, nor werethere any secondary growths to be found. The stomachshowed no evidences of ulceration, but there were slightsigns of cirrhosis of the liver. There was no peritonitis. Cancer of the ampulla of Vater was probably first described 10—2 148 DISEASES OF THE GALL-BLADDER AND BILE-DUCTS by McNeal in 1835 in the North American Arch., Baltimore,and was later drawn attention to by Stokes in 1846.* Morerecently the subject has been fully dealt with by M. Hanot,tM. Durand-Fardel,! M. Rendu and Dr. Rolleston.§ Twoforms, at least, are described, one arising from the intestinalwalls of the ampulla, and the other from the orifice of thecommon bile-duct and the pancreatic duct. They arecharacterized by intermittent jaundice, wasting, and. Fig. 42.—Cancer of Ampulla. (After drawing in Trans. Path, and Clin. Soc., Glas.) Parts shown by dividing the duct on into the duodenum : a, Terminal part ofduct with tumour ; b, c, duodenum laid open; d, pylorus; e, stomach;/, liver (shaded dark); g, collapsed gall-bladder; h, probe passed fromgall-bladder through aperture, and emerging in the midst of adherentomentum ; i, suspensory ligament. cachexia; but, as a rule, pain is absent. A typical case,ending in rupture of the gall-bladder and general perito-nitis, is described by Dr. Coats and Dr. Finlayson, and theparts figured|| in the Transactions of the Pathological andClinical Society of Glasgow (see Fig. 42). * Dublin Quarterly Journal of Medical Science, 1846. t Archives Generates de Medecine, November, 1896. % La Prcsse Medicalc, 1896. § Medical Chronicle, 1895. |i Trans. Path, and Clin. Soc. Glas., vol. iii. TUMOURS OF THE GALL-BLADDER AND BILE-DUCTS 149
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