Four Haemoglobins in One Individual

Abstract

MEDICAL JOURNALbile-ducts were found at operation, but subsequently the jaundice cleared and the babies recovered.Otherwise the only course open is a minute examination of the anatomy from the portal fissure down to the duodenum through an adequate incision in the hope that a sufficiently dilated piece of hepatic or common duct may be discovered that can be anastomosed to the intestine.If the block is below the entry of the cystic duct and the end of the common duct is very small, the gall- bladder itself can be used, and this is of course technically much easier.If the ducts appear tiny and fibrous, it is worth trying to distend them by injecting through the gall-bladder, if it is present, either saline or methylene blue.Alternatively, diodone may be used and radiographs taken on the table.Such a procedure would obviously be that of choice in those cases with tiny ducts blocked with solid material which can be washed through.Summary Four cases of congenital atresia of the bile-ducts are described in which operation for relief of obstruction was attempted, with a successful outcome in one.Microscopical examination of the liver before and three years after operation in the successful case showed complete recovery, with regeneration of damaged liver regions, restoration of biliary flow, and removal of fibrous bands that had begun to grow around the liver lobules.The clinical and pathological changes produced by congenital atresia are discussed in terms of embryology, and suggestions are put forward for a rational treatment of the condition.We are grateful to Dr.