File:Interstate medical journal (1917) (14781399184).jpg

Identifier: interstatemedica2419unse (find matches)
Title: Interstate medical journal
Year: 1917 (1910s)
Authors:
Subjects: Medicine
Publisher: St. Louis, : Interstate Medical Journal
Contributing Library: The College of Physicians of Philadelphia Historical Medical Library
Digitizing Sponsor: The College of Physicians of Philadelphia and the National Endowment for the Humanities

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ichinfection is the major feature, with or without stones. Chronic pancreatitiswith gastric symptoms cannot be cured by cholecystectomy, but requires pro-longed drainage. Question 5: What are the contraindications for cholecystectomy? 768 INTERSTATE MEDICAL JOURNAL The chief ones may be said to be the following: Inexperience of theoperator. Inexperience of the anesthetist; one who may not appreciate thefact that manipulations about the liver ducts may cause the patient to strainor cough, although fully anesthetized. Desperate condition of the patient,which will not permit any prolonged operation or any additional trauma. Inthe very obese, in whom good exposure cannot be obtained, or in the presenceof perihepatic adhesions, which make it impossible to draw the liver welldown and rotate it outward through the wound. Edema of the gastrohepaticomentum and swelling of the ducts, making it almost impossible to recognizethem, is mentioned by some. Ochsner does not think it wise to operate on
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Fig-. 5.—Drainage tube in hepatic duct. Note the close relation of the commonand hepatic ducts to the infundibulum of the gallbladder and the ease withwhich these ducts mav be injured in ligation of the cystic duct if the in-fundibulum of the gallbladder is not first lifted up, thus exposing- to viewthe cystic duct and artery. See also Fig. 2. any case in the very acute stage. Mayo Robson does not believe in removingthe gallbladder if there is no patency of the common duct. Deaver advisespassing a probe through the cystic duct, the common duct, into the duodenumin all cholecystectomies to make sure the common duct is patent. Porteradvises against removing the gallbladder if there is the slightest chance thatit may have to be used for future drainage. Frazier, Deaver, Mayo, and Crileadvise against cholecystectomy in pancreatic disease and in acute empyema.Cholecystectomy is contraindicated in patients who have already had onemajor operation performed, as a hysterectomy or umbilical h

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