. Diseases of the gall-bladder and bile-ducts, including gall-stones . 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 onlyliv
. Diseases of the gall-bladder and bile-ducts, including gall-stones . 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 bile Fig. 40.—Cysts in Liver, formed by Dilated Hepatic Ducts.(No. 2,758c, Royal College of Surgeons Museum.) Solid tumours of the bile-ducts may be simple or malignant. Simple tumour is so rare that the following case (No. 234)is worth mentioning more fully : Burins: the twelve months before coming under observa- TUMOURS OF THE GALL-BLADDER AND BILE-DUCTS 143 tion the patient, a woman, aged forty, had had repeatedattacks of what appeared to be appendicitis. Each attackbegan by acute pain in the right iliac region, associated withfever and vomiting, and followed by the appearance of atender swelling in the usual situation of the appendix, andthe ordinary symptoms and signs of a localized peritonitisin that region. At no time were there any symptoms tosuggest cholelithiasis. The patient was seen only once, after one of these seizureshad subsided, and the diagnosis of relapsing appendicitis,which had been made by her ordinary medical attendant,was confirmed. At the operation, t
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