Gall-stones and diseases of the bile-ducts . pharynx, oesophagus,duodenum, ileum, rectum, urethra, vagina, auditorymeatus, nasal duct, even the aorta itself (co-arctationof the aorta). Nearly all the writers who have interested them-selves in this question of congenital obliteration ofducts and passages have remarked that they occuralmost exclusively in the situation of what I havetermed embryologic events. This is particularlytrue in relation to the duodenum. The point atwhich the common bile-duct enters the duodenumis the spot at which the diverticulum buds outfrom the embryonic gut to form
Gall-stones and diseases of the bile-ducts . pharynx, oesophagus,duodenum, ileum, rectum, urethra, vagina, auditorymeatus, nasal duct, even the aorta itself (co-arctationof the aorta). Nearly all the writers who have interested them-selves in this question of congenital obliteration ofducts and passages have remarked that they occuralmost exclusively in the situation of what I havetermed embryologic events. This is particularlytrue in relation to the duodenum. The point atwhich the common bile-duct enters the duodenumis the spot at which the diverticulum buds outfrom the embryonic gut to form the liver. Theduodenum is apt to be constricted immediately abovethe bile papilla; occasionally it is intercepted by a OBLITERATION OF BILE-DUCTS 39 perforated diaphragm, and several specimens havebeen carefully described in which the second part ofthe duodenum has ended in a cul-de-sac; but in allthe descriptions I have read the bile-duct enteredthe distal extremity of the imperforate facts show that the primitive gut in the. Fig. V.—Parts concerned in an imperforate duodenum. and first half of the duodenum. D. second half ofthe duodenum with the common duct and gall-bladder^ Gr. B. immediate neighbourhood of the bile-papilla is theseat of much activity during foetal life, and I amdecidedly of opinion that the factors which lead toobliteration of the main bile-duct in ante-natal lifeare those which are responsible for imperforations ofthe pharynx, duodenum, ileum, anus, &c. From what we know of congenital obliteration ofthe ileum it is fair to assume that there are degrees 40 DISEASES OF THE BILE-DUCTS of narrowing or stenosis connected with the commonbile-duct, and that a morbid process beginning inante-natal life need not necessarily be complete atbirth, but continues in post-natal life. This isborne out by a case reported by Ashby. A girlaged seven years had suffered from jaundice forthirty months. The common bile-duct was obliteratednear the duod
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