Gall-stones and their surgical treatment / by B.G.A. Moynihan.

Date:
1905
Catalogue details

Licence: In copyright

Credit: Gall-stones and their surgical treatment / by B.G.A. Moynihan. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    The termination of the two ducts in the ampulla is surrounded by circular muscular fibres—the so-called “sphincter of Oddi.” These fibres are continuous with the longitudinal muscular fibres on the ducts. Variations from this normal condition of the ampulla are not common. The two ducts may open separately into the duodenum, or the canal of Wirsung may partially ; surround the lower end of the duct, being gutter-shaped, or the papilla may be absent, and in its place a depression may be seen on the duodenal wall. Diameter of the Duct.—The duct gradually narrows v from its beginning to its end. According to Padula (Brit. * Med. Journ. Supplement, Feb. 27, 1904, p. 34), the first j portion attains, with the distension which produces injec- ^ tion on the cadaver, a diameter of 7, 8, or even mm.; j the second portion is never wider than 5 mm., and the 1, third portion than mm. A gradual lessening of the diameter of the common duct is therefore one of the causes i of impaction. A stone which would pass along the first i inch of the duct would become wedged in the lower and < narrower portion. Access to the common, cystic, and hepatic ducts can be best obtained by freeing them from adhesions, introducing the finger into the foramen of Winslow, and, by gentle forward traction, fixing that part of the bile tract into which an incision is to be made. The lower part of the common duct can be reached in one of two ways, retroduodenal and transduodenal. In the i former, the duct is opened from behind, access being obtained by dividing the parietal peritoneum to the right of the descending portion of the duodenum. The peri-