. Annals of surgery. Fig. 6.—A vertical abdominal section between ascending colonand parietes on line marked A B, Fig. 7, showing rise fromX over pelvic brim. is distended, the opening in it should be closed by sutures andthe viscus returned into the abdominal cavity, and the drain leftin until the certainty of its successful closure is complete, as inCases II and IV. ^ See paper by author, British Medical Journal, November 3, 1894. 202 RUTHERFORD MORIS ON. [b) When the gall-bladder is shrunken and there is difficultyin closing the opening made in it, it may be returned unclosed asin several o
. Annals of surgery. Fig. 6.—A vertical abdominal section between ascending colonand parietes on line marked A B, Fig. 7, showing rise fromX over pelvic brim. is distended, the opening in it should be closed by sutures andthe viscus returned into the abdominal cavity, and the drain leftin until the certainty of its successful closure is complete, as inCases II and IV. ^ See paper by author, British Medical Journal, November 3, 1894. 202 RUTHERFORD MORIS ON. [b) When the gall-bladder is shrunken and there is difficultyin closing the opening made in it, it may be returned unclosed asin several of the cases recorded. (c) When a stone is impacted in the cystic dutt, it may beexcised by cutting down on it through the duct, as in Case II, or. Fig. 7.—Reflections of peritoneum from posterior abdominal B, line of section. it may be crushed when small and soft, as in Case I, after whichthe gall-bladder must be sutured to the parietes to allow of theescape of the fragments; or if the stone is hard and inaccessible, the ON GALL-STONES. 203 gall-bladder should be excised, the stone removed, and the cysticduct ligatured. When a stone is impacted in the common duct, it dependson what part of the duct it is lodged in whether the finding of itduring the operation is easy or difficult, and its removal safe orcomplicated. The stone may be, and by far most frequently is, lodged inthat portion of the common bile-duct before it dips under theduodenum and head of the pancreas, when it can be grasped andremoved by a direct incision after exposure of the portion of ductin which it is lying, the separation of (often troublesome) adhesionsbeing the chief difficulty, or it may be lodged, as in Case IV, inthe end of the duct (ampul
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Keywords: ., bookcentury1800, bookdecade1880, booksubjectsurgery, bookyear1885
