Biliary peritonitis without perforation

Stenson, Walter

doi:10.1016/s0002-9610(37)90631-7

Cited by 4 publications

(2 citation statements)

References 5 publications

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“…Both cases are of interest in that they seem to support the view of Buchanan (1918) and Stenson (1937), based on a review of some 40 cases from the literature, that biliary peritonitis cannot be explained oh any one theory. Thus Clairmont and von Haberer (1910) showed that ligation of the common duct in dogs will cause a biliary peritonitis without a perforation, and described a case following obstruction of the common duct in man.…”

Section: Comment On Cases 3-5supporting

confidence: 57%

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Some Unusual but Instructive Surgical Emergencies

Moore¹

1950

BMJ

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If the cause of acute symptoms is clear, proper treatment is begun without delay, including, if necessary, a well-placed incision. Only too often, however, the diagnosis is in doubt even in common conditions; and in uncommon ones the delays and difficulties are obviously increased.The delays which occur are shown by the following eight cases, only two of which were admitted to hospital within twelve hours of the onset of the symptoms, two being delayed for two days, two for three days, one for seven days, and one for ten days. The difficulties in diagnosis are seen in the case reports which follow, and in the literature: for instance, in strangulation of the stomach in a diaphragmatic hernia operation is commonly delayed until gangrene has occurred (Warren, 1919), in biliary peritonitis a wrong diagnosis is usual (Fifield, 1926), and in strangulation of gut through a hole in the greater omentum a correct diagnosis has not been reported.The following histories, with a brief discussion of the literature, are therefore presented in the hope that they may help in the diagnosis and treatment of future cases. A plain radiograph of the abdomen and chest showed gross small-bowel dilatation and fluid levels, the stomach below the diaphragm in its normal position, and a small loop of bowel with a fluid level within the chest, in a postero-lateral position. Strangulated Diaphragmatic HerniaGastric suction and intravenous fluids were begun and the abdomen was opened through an upper left paramedian incision. It was found that the splenic flexure of the colon had entered a diaphragmatic hernia to the left of the oesophagus and was tightly held, but the exposure was inadequate because of the distended gut. The incision was therefore continued across the rectus and into the tenth intercostal space, and the diaphragm was divided as far as the hernia, the procedure being extrapleural. It was then seen that omentum as well as gut had herniated and that the omentum was adherent to the sac, which was not lined with peritoneum. On examination (T. 980 F.-36.7' C.; P. 102; R. 24) she looked well, and was not short of breath or cyanosed. Her trachea was to the right of the midline, the apex beat to the right of the stemum, and the left side of the chest moved less than the right. There was dullness at the left base and breath sounds were absent, but neither bowel sounds nor splashing were heard in the chest, and the abdomen showed no abnormality.Radiographs of the chest showed the heart displaced to the right and a large translucent area in the left side of the chest which, at first sight, appeared to be a cyst of the lung; a barium meal, however, showed it to be stomach within the chest, but with the cardio-oesophageal junction and the pylorus in their normal positions. It is of interest to note that when the patient was lying flat and on her right side some air and barium passed on into the duodenum.On February 6 there was some lower abdominal pain and pain in the left shoulder; regurgitation of food continued. Next day the patient w...

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Section: Comment On Cases 3-5supporting

confidence: 57%

“…This is suggested by a case of Sohn's (quoted by Stenson, 1937) in which a needle was put into the common bile duct to locate it during an operation unconnected with the biliary system. The field was dry at the end of the operation, but the patient subsequently died of a biliary peritonitis.…”

Section: Comment On Cases 3-5mentioning

confidence: 99%