American medical digest. . eparating gut from liver Ifound, plastered between them, threegall stones the size of marbles. Feltmore through wall of bladder andincised the cyst, removing fifty-onemore gall stones. Gall bladder shrunkenand dry. I here present them in box;they vary in size from a grain of wheatto tip of thumb. Closed incision intogall bladder with silk, Lemberts sutures,to make the closure perfect, there being 52 THE AMERICAN MEDICAL DIGEST. no gall in bladder. I did not put in adrainage tube, as the gall had escapedin some way for years through ducts, orelse had not been poured i
American medical digest. . eparating gut from liver Ifound, plastered between them, threegall stones the size of marbles. Feltmore through wall of bladder andincised the cyst, removing fifty-onemore gall stones. Gall bladder shrunkenand dry. I here present them in box;they vary in size from a grain of wheatto tip of thumb. Closed incision intogall bladder with silk, Lemberts sutures,to make the closure perfect, there being 52 THE AMERICAN MEDICAL DIGEST. no gall in bladder. I did not put in adrainage tube, as the gall had escapedin some way for years through ducts, orelse had not been poured into the broken up extensive adhesionson surface of liver and bowels I put aglass drainage tube into the abdominalwound and closed the same around of note followed, except thatthe patient has made a good recoveryand is at this date, December 15, seem-ingly cured. The liver can now be feltto the right and slightly above theumbilicus, its lower margin at least sixinches higher than before the 1—Right lobe of liver. 2-2 Bowel adherent to —Cicatricial band dragging liver downward. 4-4 Peri-toneum everted by retractors. 5-5—Thickness of ab-dominal parietes. 6—Bowel, also adherent to —Umbilicus. 8-8.—Retractors. 9—Mons —Sup. crest ilium. Comment.—From what informationwe have, this was a case of formation ofgall stones fourteen years ago, withenlargement and rupture of gall bladder,causing local peritonitis, with resultingadhesions between liver and ascendingcolon. The alternate distension andrelaxation of this bowel may have in-creased the extent of the adhesionsdownward and inward, until the inflam-matory process firmly anchored theliver to the pelvis, by the formation ofthe dense band of tissue represented inthe figure by 3. In the Transactions of the IndianaState Society, 1879, Dr. Kemper, of Muncie, reports a case in some respectssimilar, except in the important par-ticular that Nature formed a biliary
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Keywords: ., bookcentury1800, bookdecade1880, booksubjectmedicine, bookyear188
