356 SURGICAL APPLIED ANATOMY, cchap. xvn. 



also open into either the duodenum or the transverse 

 colon, or even into the stomach or the right kidney. 

 The liver is very frequently the seat of the secondary 

 abscess of pyaemia, and, according to Mr. Bryant's 

 statistics, abscesses in this viscus are more common 

 after injuries to the head than after injuries elsewhere. 

 They are rare in pysemia following affections of the 

 urinary organs, and are equally rare in the pytemia 

 after burns. The liver is more often the seat of 

 hydatid cyst than are all the viscera taken together. 

 The cyst may discharge itself externally, or into the 

 pleural or peritoneal cavities, or into any adjacent part 

 of the intestine. 



The ga.II bladder and the bile duct have been 

 ruptured alone without rupture of the liver. The 

 injury is rapidly fatal, owing to the escape of bile into 

 the peritoneal cavity. The gall bladder is often occu- 

 pied by gall stones. These concretions are composed 

 mainly of cholesterin, and vary in size from a hemp 

 seed to a hen's egg. Although the common bile duct 

 is only about three lines in width, it is remarkable 

 to note what comparatively large stones have been 

 passed along it. The largest stones are passed direct 

 into the bowel through a nstulous tract that has been 

 established between the gall bladder and the intestine. 

 Gall stones have suppurated out through the anterior 

 belly wall, and have been removed from abscesses in 

 the parietes. Thus Dr. Burney Yeo reports a case 

 where more than one hundred gall stones were dis- 

 charged through a spontaneous fistula in the hypo- 

 gastric region, five inches below the umbilicus. In 

 cases where the bile duct is occluded by gall stones, 

 or by other causes, the gall bladder may become enor- 

 mously distended, and may form a tumour extending 

 some way beyond the umbilicus. So large a tumour has 

 been formed that the mass has been mistaken for an 

 ovarian cyst The gall bladder as it enlarges tends to 



