Gall-stones and diseases of the bile-ducts . duration the dilatationmay be very extensive. Moreover, the dilatation of the common bile-ducthas in some cases been so great that it resembled acvst, and in some instances has been mistaken foran enlarged gall-bladder, and has been opened andthe edges stitched to the skin under this impression. The effects just described follow the retention ofgall-stones in any part of the common duct, butwhen the stone is lodged in the ampulla the con-sequences may be more complicated, because in thissituation it may interfere with the outlet of thepancreatic duc
Gall-stones and diseases of the bile-ducts . duration the dilatationmay be very extensive. Moreover, the dilatation of the common bile-ducthas in some cases been so great that it resembled acvst, and in some instances has been mistaken foran enlarged gall-bladder, and has been opened andthe edges stitched to the skin under this impression. The effects just described follow the retention ofgall-stones in any part of the common duct, butwhen the stone is lodged in the ampulla the con-sequences may be more complicated, because in thissituation it may interfere with the outlet of thepancreatic duct. The complications which may arisein the pancreas secondary to the presence of acalculus in the ampulla are sufficiently important torequire separate consideration (Chap. X). There is a rare condition associated with the CHOLEDOCHAL CALCULI 87 impaction of a gall-stone in the ampulla shown inFig. 29, namely prolapse of the terminal sectionof the duct into the duodenum. This is similar tothe prolapse of the vesical segment of a ureter into. *3EFUE Fig. 29.—Second portion of the duodenum laid open to showa gall-stone impacted in the ampulla of the common a woman aged seventy years (Museum, Royal Collegeof Surgeons). the bladder when a renal calculus is too large topass: in some instances the ureter with the con-tained calculus has been known to protrude at theurethra in the case of girls and women. It is certainthat a stone impacted in the ampulla as in this 88 DISEASES OF THE BILE-DUCTS specimen would block the pancreatic duct also(Fig. 29). Biliary abscess, secondary to gall-stones.—Obstruc-tion of the main bile-ducts, especially by gall-stones,favours, as has already been pointed out, the entranceof pathogenic micro-organisms into the dilated bile-duct; as a consequence pus is formed in the dilatedportions of the ducts, and, if it were possible to makea continuous section of an intrahepatic duct in thiscondition it would resemble a stream with numerouspools or
Size: 1298px × 1925px
Photo credit: © The Reading Room / Alamy / Afripics
License: Licensed
Model Released: No
Keywords: ., bookcentury1900, bookdecade1900, bookpublishernewyorkwilliamwood
