Operative Surgery of the Gall Tracts with Original Report of Twenty Successful Cholecystenterostomies by Means of the Anastomosis Button, 1894 (Classic Reprint).cJ B Murphy
Excerpt from Operative Surgery of the Gall Tracts With Original Report of Twenty Successful Cholecystenterostomies by Means of the Anastomosis Button, 1894
Second, we will consider the functions or physiology of the gall bladder and gall tracts; for good surgery is based on good physiological principles, and good operations must be executed on good anatomical lines. Third, we will take up the individual operations, and the special indications for each.
The Gall Bladder.
The fundus of this organ lies opposite the ninth costal cartilage, close to the outer edge of the rectus, the body itself is situated in a fossa on the under surface of the right lobe of the liver, having the quadrate lobe to its left. It is in immediate contact with the hepatic flexure of the colon, and the first portion of the duodenum. The gall bladder is of pyriform outline, and when full is seen projecting beyond the anterior border of the liver, coming in contact with the abdominal wall at the cartilage of the ninth rib. It extends almost directly backward, deviating only a little to the right and upward; it measures from two and one-half to four inches in length, and one and one-half inches in diameter at the widest part, and holds about one fluidounce. It is always found full, except where some external pressure is brought to bear upon it. It is attached to the liver by connective tissue, the lower surface is covered by peritoneum, though occasionally it entirely surrounds the viscus and forms a sort of mesentery to attach it to the liver. The neck of the gall bladder gradually contracts until it forms the cystic duct. This duct is a tube an inch to an inch and a half long, which connects the neck of the gall bladder with the hepatic duct, and combines to form the common duct, or the ductus communis choledochus. The cystic duct is directed backward and to the left as it runs in the lesser omentum; the hepatic artery being to the left and the portal vein behind. The hepatic artery passes behind the hepatic duct and between it and the portal vein. This is a very important point to remember, as it assists the operator in differentiating between the duct and the vein in operations. The duct and the vein having the same color, and being situated in close proximity, it is very important to recogize the duct in this situation above the artery, and the vein below it. The hepatic duct is formed by a branch from each lobe of the liver in the transverse fissure, and is directed downward and to the right in the lesser omentum, the hepatic artery being to the left at its first part, and then behind. It is not quite two inches long and joins with the cystic duct to form the common duct.
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