Cirrhosis of the liver and icterus of four years' duration : with remarks on biliary cirrhosis / by F. Parkes Weber.

  • Frederick Parkes Weber
Date:
1896
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Licence: Public Domain Mark

Credit: Cirrhosis of the liver and icterus of four years' duration : with remarks on biliary cirrhosis / by F. Parkes Weber. 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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    bilp flow has bopn removed. It cannot, however, he over- looked that in Nasse’s experiments the duration of the ob- struction was very short, when compared to the tliree years, which the obstruction must liave lasted in the present case. In this connection, Murchison’s case No. cxxxii,'-'* to which Dr. J. Kraus, of Carlsbad, drew my attention, is of interest. It is that of a middle-aged woman, who had more or less persistent jaundice from gall stones during nearly six years, and then completely recovered. Inthls case obstruction to the bile How was clearly not com- plete all the time, for the motions during part of the time contained bile, and on one occasion it is mentioned that she vomited green bile. A very gn*at difficulty in the question of operative inter- ference is the diagnosis. In this case, we had no definite history of previous biliary colic ; how, therefore, without an exploratory operation, could the case have been distinguished from one of Hanot’s cases of liypertrophied cirrhosis, not due to gall stones ? Unfortunately, it does not at present seem jjrobabe that tlie new Roentgen photography will help much in the diagnosis of such cases, for the j' rays pass almost as easily through gall-stones as through the surrounding tissues. The operation of choledocholithotomy, first successfully performed in 1890 by 1.. G. Courvoisier,^^ has very many times already been successful. Such recent successes, as those recorded by Fenger and others, are noteworthy. Occasionally also the stone can be crushed between the fingers, through the walls of the duct, and the fragments pressed onwards through the orifice into the duodenum, as was lately successfully accomplished by Professor Sonnen- burg.^' In the. present case, however, the marked hasmoiThagic tendency, as evidenced by epistaxis and hemorrhoidal bleeding, would have constituted a special danger for any operative interference. 1 know of no case where jaundice, due to obstruction in the common bile duct, has lasted three years, in which an opera- tion has actually been performed, excepting one case re- corded by Dr. Hans Kehr, of llalberstadt.'^’ It was that of a woman, aged 40, who ten years previously liad suffered from cholelithiasis, and had been jaundiced for the last four years. The jaundice was deep, the liver was enlarged, but the gall bladder could not be palpated; the patient was emaciated and suffered from pruritus. At the operation three large calculi were removed from the common bile duct, but unfortunately the patient died of septic peritonitis due to extravasation of faecal matter from a spot in the trans- verse colon where some adhesion with the gall bladder had been torn through during the operation. The state of the liver at the necropsy is not mentioned. Even when the cause of obstruction in the common bile duct cannot be removed, the patient might sometimes be relieved by a cholecystostomy from the intolerable itching due to the jaundice. In cases where the obstruction is due to malignant disease this C. Murchison, Clinical Lecltircs on Diseases of the Liver, third edition, London, 1885, p. 417. L. G. Courvoisier, Casuistisch-statistische Britraege zur Pathologie und Chirurgie der Oallenwege, Leipzig, 1890. Loc. cil. ** Berl. klin. Woch., 1896, p. j4t. Devt. Zeitschrift fUr Chirurgie, 1894, vol. xxxviii, p. 361.
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