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Miss J. de M. had a pelvic operation two years before consulting me. A few days after the operation she was taken with pain over the region of the liver, and a swelling, which appeared in the midaxillary line, was incised and discharged pus, leaving a persistent fistula between the tenth and eleventh ribs. She asked to be relieved of this fistula.
In order to know the direction of this fistula, I injected about 2 ounces of petrolatum paste and bismuth with a melting point of 110 F. Immediately there was considerable pain in the pit of the stomach, the following day the patient's temperature was 102 by mouth, the urine was dark brown, she was jaundiced, and she could not hold anything on her stomach. Figure 1 shows the bile ducts filled with the paste down to the duodenum.
The treatment consisted of local hot applications, morphin for the
Reich A. ACCIDENTAL INJECTION OF BILE DUCTS WITH PETROLATUM AND BISMUTH PASTE. JAMA. 1918;71(19):1555. doi:https://doi.org/10.1001/jama.1918.26020450002010b
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