. A new manual of surgery, civil and military. gall-bladder, with its diverticulum, was removed, leaving a punched-outcylindrical opening in the liver (Fig. 3). The gall-bladder contained yellowish stained mucoidmaterial and the mucosa was reddened, edematous and rugged, suggestive of chronic inflamma-tion. The appendix was found somewhat enlarged at its distal end, and there was a partialconstriction 1 cm. from the cecal end. The appendix was removed. This is undoubtedly a congenital anomaly of the gall-bladder, since no evidences ofsevere inflammation nor injury were found in this region. Et
. A new manual of surgery, civil and military. gall-bladder, with its diverticulum, was removed, leaving a punched-outcylindrical opening in the liver (Fig. 3). The gall-bladder contained yellowish stained mucoidmaterial and the mucosa was reddened, edematous and rugged, suggestive of chronic inflamma-tion. The appendix was found somewhat enlarged at its distal end, and there was a partialconstriction 1 cm. from the cecal end. The appendix was removed. This is undoubtedly a congenital anomaly of the gall-bladder, since no evidences ofsevere inflammation nor injury were found in this region. Etiology. It is difficult to ascribe a cause for this condition, since in the study ofcomparative anatomy there have been found no real perforations of the liver by the gall-bladder. Deve thinks that the condition is due to the fusion, in embryonic life, of the twolobar surfaces of a deep incisura. In a systematic post-mortem examination of 130 childrenof all ages, he found a completely perforating gall-bladder in one case and partial perfora-. Gall-Bladder Removed in a Case of Perforating Hernia of the Gall-Bladder Through THE Liver. tions in two cases. In eight other instances he found the fundus of the gall-bladder more orless embedded in the liver. He never found the condition in adults, which, he thinks, is dueto pressure atrophy of the hepatic bridge from pressure of the abdominal wall and of adistended gall-bladder. OBSTRUCTION OF THE CYSTIC DUCT Obstruction of the cystic duct causes retention of fluid in the gall blad-der with a rapid distension thereof behind the obstruction. This fluid con-sists of mucus if the infection is slight, or of muco-pus if the infection is moresevere. The bile that may be in the gall bladder at the time the obstructionoccurs is rapidly absorbed, leaving either the clear mucus or turbid fluid,according to the amount of infection. The distended gall bladder may reachan enormous size and usually becomes palpable. If the inflammatory processbe ver
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Keywords: ., bookcentury1900, bookdecade1910, bookpublishe, booksubjectsurgery
