Symptoms of obstructive jaundice invariably create a serious problem for the surgeon, if an operation is to be performed to relieve either the jaundice or some other intercurrent symptom. The physical resistance of this group of patients is lowered; but this, in itself, does not constitute the major surgical problem. Hemorrhage, frequently not responsive to any type of treatment, and ending in death, is the factor that renders surgical judgment difficult in every instance of obstructive jaundice. In the present state of our knowledge, it is not easy to say with positive assurance what agency is directly responsible for this tendency to bleed. As surgeons we have become accustomed to associate a prolonged clotting time with obstructive jaundice; however, we are not warranted even in taking this seemingly well established position. We would be on safer ground if we regarded every jaundiced patient as
SEELIG MG. LOCALIZED GANGRENE FOLLOWING THE HYPODERMIC ADMINISTRATION OF CALCIUM CHLORID. JAMA. 1925;84(19):1413–1414. doi:10.1001/jama.1925.02660450021012
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