This case is presented as one which is rather typical of an injury to the common duct during cholecystectomy. Anomalies of the duct account for a few accidents, but the majority result from incomplete exposure of the duct during operation or clamping blindly for hemorrhage in cases where the cystic artery slips away from the clamp or the ligature becomes loose. The cystic artery is a branch of the right hepatic and comes off at a level above the cystic duct so that in our cases the damage has invariably been in the hepatic duct at a distance of one-fourth to one inch below the bifurcation of the right and left hepatic duct.
The diagrammatic sketch shown in figure 1 shows also that the right hepatic artery may he clamped and tied off if the hemostats are put on blindly, leading to damage to the right lobe of the liver. In the case reported here, the physician stated that the gallbladder was acutely inflamed and, during the operation, he encountered severe hemorrhage which necessitated the blind application of the hemostat. This can easily be avoided, however, if one places the finger in the foramen of Winslow and compresses the gastric hepatic omentum, through which the main vessels run, between the thumb and forefinger. Then on gradual release of pressure, the one bleeding point may be picked up and drainage to the duct obviated.
I have now performed hepatico- or choledocho-duodenostomies in 10 cases. Most of these were necessary because of. . .