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May 2, 1914


JAMA. 1914;LXII(18):1373-1374. doi:10.1001/jama.1914.02560430003002

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Drainage of the common duct presents three dangers: much bile is lost, cicatricial contraction occasionally occurs, and should the drain-tube be occluded, or even if it be not occluded, bile may escape into and infect the peritoneal cavity beyond the field of operation.

Owing to an interesting physiologic fact, the loss of bile may become a serious danger—a danger which is usually overlooked—as normally the bile passes through the intestinal tract, and the bile-salts are reabsorbed, return to the liver, again become a constituent of fluid bile, and thus continue their circuit. The continuous loss of bile by drainage in a good-risk patient may cause no apparent damage, but in elderly subjects and in poor risks from any cause, the steady loss of bile-salts and of fluid may prove fatal. In gallbladder drainage the bile can be collected and, as Yates has suggested, may be returned to the bowel; but

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