The Abdomen 207 



days with symptoms of profound icterus. Ante-mortem diagnosis 

 would be almost impossible without explorative celiotomy. 



Treatment, The only effective treatment in cases of this 

 nature is to remove the obstruction by incising immediately over 

 it and afterwards suturing, as is performed quite commonly in 

 human surgery. 



Surgery of the Liver 



It is possible to remove a considerable portion of the liver 

 without endangering life or health. According to Ponfick, three- 

 fourths of the organ may be extirpated in the rabbit, and the 

 lost portion will become replaced within a few weeks by regenera- 

 tion of specific liver tissue. Gluck endeavored to extirpate the en- 

 tire organ in several animals. Of these, two were alive the morn- 

 ing of the seventh day and eating well, but the remainder died 

 of peritonitis or thrombophlebitis of the inferior vena cava soon 

 after the operation, though no necrosis of the ligated portion fol- 

 lowed when strict asepsis had been observed, nor was there any 

 secondary hemorrhage. It was found impossible tb completely 

 excise the organ because of the inferior vena cava being solidly 

 embedded in the Spigelian lobe. 



The operation of Cholecysto-enterostomy, the establishment 

 of artificial connection between the gall-bladder and part of the 

 intestine, generally the duodenum, has been successfully performed 

 experimentally. L. R. Mueller records an instance of natural 

 union between a cholecystic gall-bladder and the intestinal tract 

 by development of an intercommunicating fistula. He divided the 

 bile-duct after having doubly ligated it. In spite of this the severed 

 ends reunited, the ligatures became partly encapsulated and the 

 canal regained slight permeability. Murphy has done the opera- 

 tion by means of his anastomosis-button. Previously, Colzi, De 

 Page, Harley, and others had experimented on dogs by suturing 

 the wall of the gall-bladder to that of the duodenum, and establish- 

 ing a fistula between the two through chemical destruction or in- 

 cision within the circle formed by the sutures. At the necropsies 

 which Murphy conducted after the animals had recovered and had 

 been destroyed it was found that a valve had invariably formed 

 on the intestinal side of the opening, thus preventing the contents 

 of the duodenum from finding ingress into the bladder. 



