THE following case-history is that of a patient who entered t h e Montreal General Hospital with the signs and symptoms of acute cholecystitis. She was admitted into t h e service of Professor A. T. Bazin, who at operation found her illness t o have resulted from a hzmorrhage into a non-parasitic cyst of t h e liver.
CASE REPORT.
HISTORY.-Mrs.
M., 61 years of age, for thirty-five years had had recurring attacks of distress following the eating of certain foods. These attacks, which were often months apart, came on a t various periods after meals, lasted from one to six hours, cleared up spontaneously, and were characterized by a sense of weight in the epigastrium, eructations of gas, nausea, and sometimes vomiting. They were never accompanied by fever, chills, pain, melaena, or clay-coloured stools. Several weeks before admission t o the hospital the patient noticed a 'lump' in the right upper quadrant. This did not increase in size and gave no symptoms until two weeks previous to admission, when she was suddenly seized with a knife-like pain across the upper abdomen. The pain was so acute and so severe that it was not relieved by hot applications or a hypodermic of morphine. This pain, which at times radiated to the back and both shoulders, lasted for two hours, and was accompanied by profuse perspiration, nausea, and repeated vomiting. For several days following there was soreness in the right upper quadrant, anorexia, slight nausea, and general malaise. There were no chills, fever, or subsequent jaundice.
Ox EXAMINATION.-on admission to hospital physical examination showed a well-developed, somewhat obese female. There was swelling and tenderness in the right upper quadrant of the abdomen, and Murphy's sign was positive. The liver edge was felt two finger-breadths below the right costal margin, but no mass could be palpated. Red blood-cells 4,800,000, white blood-cells 5400, and haemoglobin 55 per cent.
X-ray examination of the gall-bladder was negative.
Oi'ERATIoN.-Professor Bazin, who operated upon the patient under gas-oxygen anzsthesia, found a dark-bluish globular cyst projecting from the anterior margin of the right lobe of the liver (Fig. 501). The free surfaces of the cyst were covered with thickened peritoneum, which in places was arranged in strands. On palpation this cyst was found t o extend some distance into the liver substance, and involved