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the patient coming from an insane asylum, presenting the picture of an acute gallstone attack, with profound icterus. The pain was severe. The case was diagnosed as gallstones, with probably the escape of the gallstone through the intestinal wall. A definite lump could be: felt in that region, anel they founel dense adhesionsdoi:10.1056/nejm191002241620809 fatcat:nvu54lpedfaq7ehs3jbd6mshb4