Large bile cyst of the liver : jaundice without cholelithiasis : incision and drainage : recovery / by Alban Doran.

  • Doran, Alban H. G. (Alban Henry Griffiths), 1849-1927.
Date:
[1903]
Catalogue details

Licence: In copyright

Credit: Large bile cyst of the liver : jaundice without cholelithiasis : incision and drainage : recovery / by Alban Doran. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    reasonably infers that this condition explains why stones often pass from an abdominal wound when the gall-bladder and the three ducts have recently been cleared of calcnlid Lastly^ in my own case there were no calculi either in the liver cyst or outside it. The above cases seem to me worth considering in relation both to bile cysts in the liver and to the development of calculi. The Westminster Hospital S]3ecimen seems to prove the theory that gall- stones may originate in the liver, whilst the weight of evidence from the other cases above related is in favour of Waring’s opinion that as a rule they begin in the gall- bladder. Having made some mention of other cases of bile cyst in the liver, I will now dwell on certain more or less essential features in my own case. The cause : injury or pregnancy ?—The history of a blow on the right hypochondrium, nearly three years before the jaundice set in is, to say the least, highly sug- gestive. It was severe, and abortion followed in a few hours. This blow might have caused the rupture of a duct inside the liver, followed by very slow extravasation of bile into bruised liver-substance around it. A cystic cavity could thus be formed, and ultimately all the bile secreted in the liver might be poured into the c}^st. The pressure of the cyst in some way prevented the passage of the bile into the hepatic ducts ; possibly, however, a small calculus blocked each of the main ducts which unite in the transverse fissure to form the hepatic duct, calculi. One of these has been dislodged from its bed, and is stitched to the surrounding liver substance. “ History.—The specimen is from a liver which was similarly affected throughout its whole extent. The gall-bladder was full of stones, but was but little dilated. The obstruction was caused by the pressure of a hydatid cyst, about the size of a small orange, which was growing in the portal fissure. Presented hy Mr. Stonham.” Some of the calculi are quite a quarter of an inch in diameter. 1 I must add Eolleston’s case, “ Large Intra-hepatic Calculi in Dia- betes,” ‘ Trans. Path. Soc., vol. xliv, p. 133, where the gall-bladder and the three ducts “ did not contain any calculi and were not dilated.” In that respect it was homologous with my own case of bile cyst.