Aortic embolectomy report of a successful case

Abstract

gall-bladder. The continued leak of blood from this sinus nearly two months after the first operation showed that there was a feed of fresh blood to the central core of the clot and this blood had seeped through the clot to the exterior through the sinus.The sinus from the fundus of a scarred gall-bladder to the anterior abdominal wall, at the site at which a drainagetube had been previously inserted, made it evident that at the first operation the gall-bladder had been drained. Had an attempt been made to excise this gall-bladder and had this attempt been abandoned on account of bleeding resulting from this dissection ? It seems very likely that this was the case. The vomiting of bloodclots on two occasions after the first operation and the passing of blood per rectum on the second of these occasions makes it evident that the aneurysm had bled into the duodenum, and it is likely that this occurred through the orifice seen in the first part of the duodenum when the aneurysmal walls were wiped away. Altogether a fascinating set of deductions. A mass of encapsulated clot at the porta hepatis walling off two holes in the hepatic artery, a large hole on the wall of the gall-bladder, and a hole in the wall of the duodenum, saving the patient from three operative injuries, any one of which could have been sufficient to determine his death.