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:
1904
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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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    analysed. There was no true pedicle; the attached portion of the cyst was left behind and fixed to the upper part of the abdominal wound. Death occurred in thirty- six hours. All organs were found healthy, even the liver. It is very doubtful if this cyst had anything to do with the bile-ducts in the liver. Langenbucli, relying on the original report in the ‘ British Medical Journal ’ (vol. ii, 1874, p. 700), observes that it is not clear that the cyst was not of hydatid origin; but Dr. Goodhart, who exa- mined it when it was mounted as a specimen in the museum of the College of Surgeons (Path. Series No. 2758), could find no hydatid elements in the. cyst. I will now give a short summary of five cases where a unilocular, not hydatid cyst lay inside the liver. Frederick Bird, of Melbourne, in a case reported by Kilvington, diagnosed a tumour of the liver as not hydatid because the low tension defined by palpation contrasted with that so prominent in hydatid disease. The cyst was opened, fixed to the parietes, and drained. Two years later another developed in the liver, or else the old cyst had filled again. Nothing is said about its contents, but Kilvington includes it under simple cysts which, ho states, contain albuminous fluid, and neither bile nor jaundice are mentioned. Bayer, of Prague, operated on a multiparous woman aged 56, subject to fluctuating swelling in the region of the liver for four months, with pallor, but no jaundice, and irregular action of the bowels. The cyst contained eight litres, or over thirteen and a half pints, of a brownish-grey fluid; it was drained, and fluid, which never contained bile, escaped for some time. A few months after the operation the cavity suppurated, but the patient ultimately did well. Bayer attempts to trace the origin of the cyst to an old and extensive inflammatory process along the gall-ducts, but admits that the pathology of the case was not evident. Winckler’s patient was a woman aged 38. As in Ward Cousins’ case, ovarian cystic disease was suspected.