A clinical lecture on dilatation of the gall bladder simulating ovarian cyst : delivered at the Samaritan Free Hospital for Women / by Alban Doran.

  • Doran, Alban H. G. (Alban Henry Griffiths), 1849-1927.
Date:
1905
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Credit: A clinical lecture on dilatation of the gall bladder simulating ovarian cyst : delivered at the Samaritan Free Hospital for Women / 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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    piece of the sac that was united to the abdominal wall; the peritoneum seemed not to be open.” The excised portion proved, on microscopical examination, to be part of the wall of the gall bladder. A calculus remained encysted in the cystic duct or neck of the gall bladder, and a fistula de- veloped; but the patient, who remained in good general health ten years alter the operation, declined to submit to any further surgical treatment. Althouih these cases of extreme cystic dilatation of the gall bladder seem almost confined to female patients, the very largest (Erdmann6), if we may feel sure of the diagnosis, occurred in a man aged 24. Sixty to eighty pounds of bile- stained fluid were removed by tapping; the fluid collected again slowly, but the patient left hospital and never returned. As no exploratory operation was undertaken, the relations of the cyst remain unknown. It was most probably a cystic gall bladder, but it might have developed inside the liver as a bile cyst, the gall bladder and ducts remaining normal. I have already reported a similar case in my own operative practice,3 with notes on others already published. A cyst of this kind is figured without any history, in Hektoen and Ries- man’s Textbook of Pathology, p. 817. Class 11.—Cystic gall bladders forming distinct tumours of considerable size, but confined to the right side of the abdomen, are of much interest in respect to diagnosis. A tumour of this class may simulate very closely a cystic right kidney or an ovarian cyst dis- placed and adherent to the structures in the right lumbar region, a condition not rare in multiparae. Kocher’s case7 is the most typical of this class. A woman aged thirty was sent into hospital subject to a tumour which had been diagnosed as an ovarian cyst. On careful inquiry it trans- pired that during the fifteen months which had passed since the swelling was first observed the patient had sudden attacks of pain, accompanied on one occasion by transitory jaundice. Kocher detected a tense oval tumour “of the size of a man’s head” in the right side of the abdomen. It was freely movable, its lower pole could be pushed down below the level of the pubes, but the uterus and appendages were not con- nected with it. It proved to be a large empyema of the gall bladder, with a wall about a centimetre, or nearly two-filths of an inch, in thickness. A great quantity of pus and about forty-five gall stones were removed. A drainage tube was inserted and the track ultimately closed; no bile ever issued from it. About ten years ago Tuffier3 had under his care a nun, aged 40, with a tumour of the size of a fetal head, situated between the false ribs and the umbilicus. It was round and smooth and followed respiratory movements. It could not be pushed back into the lumbar region. The history and the fact that dullness on percussion could be traced from the tumour to the hepatic region soon dispelled the suspicion that the tumour might be ovarian. The patient had been subject for seven years to epigastric pains coming on after meais. As in my own case, there was no history of siekness nor of jaundice. Movable kidney had been diagnosed and a belt applied; it of course gave no relief. The patient was kept at rest for several months. The swelling became enormous, and in this later stage might well have been taken for an ovarian cyst—indeed, it almost came under Class I. The result of opera-