. Diseases of the gall-bladder and bile-ducts, including gall-stones . h the tube inserted into the cyst afterit had been stitched to the abdominal wall. As a result ofan attempt to connect the cyst with the bowel, peritonitis wasset up, and the patient succumbed. At the autopsy, the cystwas found to be firmly attached to the under surface of theliver, and seemed to be formed by enormous distension of thecommon and cystic ducts. The hepatic duct opened intothe cavity, but there was no communication between it andthe duodenum. Specimen No. 1,419, Guys Museum, shows a dilatation ofthe common bil
. Diseases of the gall-bladder and bile-ducts, including gall-stones . h the tube inserted into the cyst afterit had been stitched to the abdominal wall. As a result ofan attempt to connect the cyst with the bowel, peritonitis wasset up, and the patient succumbed. At the autopsy, the cystwas found to be firmly attached to the under surface of theliver, and seemed to be formed by enormous distension of thecommon and cystic ducts. The hepatic duct opened intothe cavity, but there was no communication between it andthe duodenum. Specimen No. 1,419, Guys Museum, shows a dilatation ofthe common bile-duct. There is a thick-walled cyst 6 inchesacross, representing the common bile-duct; the portion of * Medical Chronicle, October, 1898. TUMOURS OF THE GALL-BLADDER AND BILE-DUCTS 141 duct below this is less than the normal calibre, and has avalvular fold, which completely obstructs the lumen. Thetumour was aspirated twice, 3^ pints of bile being withdrawnon each occasion without relief. Then choledochostomy wasperformed, and death ensued two days after (Fig. 39).. Fig. 39.—Dilated Common Bile-duct, forming a Thick-walled Cyst6 Inches in Diameter. The terminal f inch of the duct was less than the normal calibre, with avalvular fold completely obstructing the lumen. It was twice aspiratedof 3^ pints of bile, and finally choledochostomy was performed, but thepatient died two days after. (No. 1,419, Guys Museum.) Dr. Arnison had a case under his care in 1891, where heoperated on what was apparently a pancreatic cyst, which hedrained. The patient was extremely ill at the time, and onlylived a few days. At the autopsy the operation was found tohave been a choledochostomy, and the tumour to have beena dilated common bile-duct. 142 DISEASES OF THE GALL-BLADDER AND BILE-DUCTS In the Hunterian Museum is a large tumour (Fig. 40) ofthe liver constituted by dilated hepatic ducts, which form aseries of cysts within the substance of the liver itself. Therewas no obstruction in the main b
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