Case of aneurism of the hepatic artery with multiple abscesses of the liver / by George Ross and William Osler.

  • Ross, George, 1845-1892.
Date:
1877
Catalogue details

Licence: Public Domain Mark

Credit: Case of aneurism of the hepatic artery with multiple abscesses of the liver / by George Ross and William Osler. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    Intestines normal. No trace of ulceration in the large intestine. Bladder and prostate, normal. Liver, 4879\ grammes, (lOf lbs). The peritoneum around it in many places showing signs of inflammation. The left lobe intimately adherent to the stomach by a thick layer of firm yellowish-coloured lymph. The right lobe also cemented to parts in its neighbourhood by lymph of a similar character. A small amount is also observed on the descending colon, but the general peritoneal surface is not affected, the serous covering of the intestines being clear and glistening. The liver itself retains its normal shape, the upper surface is smooth and not adherent. Towards the right border a yellowish-coloured swelling is evident which is perceptibly fluctuating. Other less distinct yellowish spots are seen scattered over the organ. To the touch the upper and back part of the right lobe is exceedingly soft and fluctuat- ing. On the under surface many yellowish-white nodules are apparent, some large, others quite small, all distinctly fluctuat- ing. A similar one of large size is apparent on the under surface of the left lobe. A transverse incision through both lobes reveals the fact that we have to deal with a diffuse suppurative hepatitis. An immense quantity of yellowish-white, custard-like pus flowed out. The right lobe is completely honey-combed by a series of small, closely united abscesses, ranging in size from a marble to a walnut. The septa between these absceses are composed of a dark-red tissue. Most of these small abscesses communicate together; some have merged to form larger ones. They all possess distinct lining membranes which are frequently stained with bile. The left lobe is in a similar condition, and in both the abscesses extend throughout the thickness of the organ. Thus, the only portions of liver-substance which are found comparatively free are the lobus quadratus and that portion of the organ lying immediately above and a little to the left of the gall bladder. These parts on section are of a dark colour, lobules distinct, small bile vessels very evident. The gall- bladder is small, contains about three drachms of a clear, some- what viscid secretion. On pressing it and along its ducts no fluid could be forced out at the papilla biliaria. It was with