Gall-stones and diseases of the bile-ducts . rinrs). The relations of the common bile-duct to theadjacent organs are of great practical importanceto the surgeon. Quenu suggested that it is con-venient to divide it for descriptive purposes andclinical reference into three portions : (1) The supraduodenal portion (35 cm.). (2) The pancreatic (or retroduodenal) portion(2*5 cm.). (3) The duodenal (infraduodenal) or terminalportion (1*5 cm.). The supraduodenal portion extends from thejunction of the cystic duct to the point where thecommon duct comes into relation with the part lies i
Gall-stones and diseases of the bile-ducts . rinrs). The relations of the common bile-duct to theadjacent organs are of great practical importanceto the surgeon. Quenu suggested that it is con-venient to divide it for descriptive purposes andclinical reference into three portions : (1) The supraduodenal portion (35 cm.). (2) The pancreatic (or retroduodenal) portion(2*5 cm.). (3) The duodenal (infraduodenal) or terminalportion (1*5 cm.). The supraduodenal portion extends from thejunction of the cystic duct to the point where thecommon duct comes into relation with the part lies in the gastro-hepatic omentum and isin relation with the foramen of Winslow. It re- 10 DISEASES OF THE BILE-DUCTS presents nearly half the total length of the duct,and is crossed near its termination by a twig of thepancreatico-duodenal artery; occasionally it is alarge vessel (Qnenu). The pancreatic portion usually occupies a tunnelin the head of the pancreas : in some cases it ismerely a groove. The terminal segment lies in the wall of the. VEIN Fig. 5.—The relations of the bile:ducts, portal vein, and hepaticartery at the porta hepatica. duodenum and opens into the ampulla, save in thenstances when this diverticulum is absent, then itmay open on the free surface of the duodenalmucous membrane : it is the shortest segment. It will be seen on reference to the diagram () that the cystic duct with the gall-bladder may beregarded from the anatomic point of view as adiverticulum from the main bile-duct. In considering the anatomy of these ducts it is THE GALL-BLADDER 11 important to remember that they are imbedded inareolar tissue, which often contains a large amountof fat, and they are in close relation with the maintrunk of the portal vein and the hepatic artery ;numerous small blood-vessels ramify on the walls ofthe ducts, as well as sympathetic nerve-twigs ofsome size derived from the cceliac plexus, includingthe terminal twigs of the left vagus nerve. The fatin which th
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