Duodenal tube biliary tract drainage A 25 year “follow-up” report on Anna Ingber Penn, the first person to undergo treatment by this method

Conclusions

This 25 year report of ‘just one case’ has taught us several things that justify the following conclusions.

First. Intelligent and friendly cooperation between the surgical and medical divisions is imperative. We should work together for the best interests of the patient. We should avoid the rivalries that have, in the past, been responsible for losing some lives or producing some chronic gastro-intestinal invalids.

Second. The sick liver has a great ‘margin of reserve.’ It has a remarkable capacity for recovery, if given a proper chance.

Third. Our present functional liver tests are inadequate for the accurate appraisal of an actually damaged liver such as Anna Penn’s, especially during quiescent periods. Possibly some of them could be discarded. Better ones are greatly needed.

Fourth. Chronic liver disease, such as have been referred to, have a natural tendency to pathologically progress, and to symptomatically relapse, often because of neglect. We have learned that the frequency of relapse and the progress of the disease can be reduced by appropriate and keener watchfulness, and by more complete treatment.

Fifth. Duodenal tube biliary drainage of theliver possesses great potential usefulness in patients like the one reported, and particularly so when further surgery is not considered practical. This author has successfully treated a large number of cases, similar in many respects to this one. Among them are cases of hepatitis ; of hepato-cholangitis ; of early cirrhosis ; of subacute necrosis; of liver or gall bladder typhoid carriers ; of patients with hepatic-intestinal toxemia (4), a diagnosis not yet officially recognized. These patients have been restored to relatively good health by adding duodenal tube biliary drainage of their sick livers, that isexternal bile drainage, to an otherwise medical or surgical regimen. The literature now contains many similar experiences reported by others.