Transactions of the American Association of Obstetricians, Gynecologists, and Abdominal Surgeons for the year ... . ition is resumed. Recurrent, so-called bilious attacks withvomiting, are common. Actual pain is rare; when, however, a band isattached well down on the gall bladder, toward or involving the ducts, 56 HAROLD D. MEEKER sharp pain simulating gallstone colic may occur. Tenderness may alwaysbe elicited by making traction on the fixed points of the band. In the second or uncomplicated cases of pseudocholecystitis, the pa-tients are well nourished, do not show indications of intestinal
Transactions of the American Association of Obstetricians, Gynecologists, and Abdominal Surgeons for the year ... . ition is resumed. Recurrent, so-called bilious attacks withvomiting, are common. Actual pain is rare; when, however, a band isattached well down on the gall bladder, toward or involving the ducts, 56 HAROLD D. MEEKER sharp pain simulating gallstone colic may occur. Tenderness may alwaysbe elicited by making traction on the fixed points of the band. In the second or uncomplicated cases of pseudocholecystitis, the pa-tients are well nourished, do not show indications of intestinal toxemiaand complain only of such local distress in the upper abdomen as hasjust been cited. The diagnosis of the various types of bands which maycause a pseudocholecystitis, will be considered separately in order oftheir most frequent occurrence. 1. Cholecystocolic Band.—This type occurred in 47 per cent of the140 cases. The upper limit of the band is usually attached to thefundus of the gall bladder but may extend to the base of the cysticduct. The lower end is attached to the upper border of the transverse. Fig. 3.—Cholecystoduodenal band showing drag on gall bladder and constriction of duodenum. colon, with prolongations extending to the transverse bands vary in density, most being rather delicate, fibrous, anddo not bleed when divided. The usual subjective symptoms have beenalluded to. In the physical examination, direct pressure over the gallbladder gives rise to slight tenderness, deep pressure over the trans-verse colon just below the gall bladder also gives rise to slight tender-ness, but the moment the direct pressure at this point is changed todownward traction, pain is elicited not only under the finger tips butalso at a point several inches above the examining fingers. This pro-cedure may cause sharp pain in the back and shoulder. This type ofband may cause a degree of duodenal constriction depending upon itsstructure and point of attachment to t
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