helpful in this connection : ( 1 ) it is rare for a patient with common duct stone not to have had colic at some time and (2) it is rare for a stone to cause complete obstruction of the ducts for any length of time.Strictures.-Postoperative strictures of the biliary ducts are on the increase and as always present a grave problem for the surgeon. Diagnosis, however, is easy if the examining physician inquires carefully into the postoperative course of the patient. A story of intermittent jaundice with biliary fistula which alternately opened and closed is almost diagnostic. In late cases splenomegaly and vascular spiders are not uncommon, pruritus is severe, and latent hemorrhagic tendencies are often detected. Laboratory studies often indicate evidence of injury to the parenchyma of the liver, which is not ordinarily of a degree to interfere with successful surgical results.
Chronic Destructive Pancreatitis With or WithoutStones.-Chronic destructive pancreatitis with or without stones is commoner than is generally believed. It may be recognized by the persistence and severity of its painful seizures, by the fact that it may be associated with steatorrhea, fatty liver and diabetes mellitus and by the evidence of régurgitation of pancreatic enzymes, lipase and amylase, into the blood stream. It is a dramatic and violent disease, unlike the insidious pancreatic carcinoma. It rarely produces complete biliary obstruction and may pass through numerous episodes without demonstrable icterus.
INDICATIONS AND CONTRAINDICATIONS TO SURGICAL TREATMENT