Gall-stones and diseases of the bile-ducts . 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 fo
Gall-stones and diseases of the bile-ducts . 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. Fig. 34.—Portion of the liver, with the gall-bladder, pyloricsection of the stomach, and duodenum. The gall-bladdercommunicates with the duodeniun by an opening which allowedthe gall-stone in the preceding figure to enter the duodenum. me very probable that this is a common order to show the intimate relation of the gall-bladder to the first segment of the duodenum I have 102 DISEASES OF THE BILE-DUCTS introduced Symingtons excellent drawing (Fig. 35),which demonstrates the relationship in an accurateand artistic manner. This drawing also shows thepropinquity of pylorus and gall-bladder, and helpsto explain, not only the frequent occurrence of vonrit-
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Keywords: ., bookcentury1900, bookdecade1900, bookpublishernewyorkwilliamwood
