A
CASE OF LARGE
YOUNG
Macpherson
J.
Physician
TUMOUR IN A
OVARIAN GIRL.
Lawrie, M.D., to the
Weymouth
C.M.
Glasg.,
Sanatorium.
C., unmarried, a delicate, fragile girl of 16, was admitted into the Weymouth Sanatorium on the 25th of March, 1892, on account of a gradually increasing enlargement of the abdomen of about two years' duration. Her general health had been fairly good. The menstrual discharge appeared at intervals of about two weeks, and was rather profuse. Her ailment caused her a good deal Elizabeth
of discomfort and
some
pain,
of
and she had become the
in her
unjust suspicion neighbourhood. examination, a large, prominent swelling was found, occupying the greater part of the abdominal cavity and extending up to the ensiform cartilage. The cirobject
On
cumference of the
forty area.
inches. The
the flanks.
body
at the level of the umbilicus was
Fluctuation
was
distinct
over a
considerable
note
was dull, except low down in percussion On vaginal examination, the fundus uteri,
easily defined, was found pushed over towards the left; and, filling up the right half of the pelvis, an irregular hard swelling could be felt continuous with that
not
in the abdomen. The
operation
was
performed in long was
incision about three inches
the usual way. An made in the middle
LARGE
line.
Several arteries
exposed was
OVARIAN
TUMOUR IN YOUNG
up and the cyst was Spencer Wells's trocar
caught
were
without much trouble.
introduced at the most
siderable
quantity
187
GIRL.
prominent part,
of brown fluid evacuated.
and
a
con-
The trocar
withdrawn and the aperture in the cyst enlarged. On introducing my hand, the tumour was found to be in
was
great part solid, and it
important enlarge
was
impossible
reduction in its size.
to
the abdominal
scissors in
an
It
accomplish any became necessary which was done with
incision, upward direction, and
trouble the tumour
was
to
now
after
a
deal of
good
drawn out of the abdomen. the
On
in three
breadth, ligatured pedicle portions and divided. After cleansing the peritoneal cavity, the edges of the wound were brought together account of its
was
eleven silk-worm gut sutures, and the operation completed with a dressing of iodoform gauze. The tumour and its contents weighed over twenty-five pounds.
with
The further progress of the temperature did not rise over
case
The
day
was
At the end of
normal.
found healed and the sutures was
quite
This
well in
case
a
was
and
ioo?,
on
the third
week the wound and the
removed,
fortnight. contrasts strongly
satisfactory. was
patient
a
with that of
a
patient
in the Sanatorium last year, from whom I removed an ovarian tumour, complicated with chronic peritonitis and The patient was a married woman, and the of mother of five children. She 37 years age, had noticed for two years a slowly increasing enlargement of the abdomen. An attack of peritonitis supervened extensive adhesions.1
and
away, leaving the general She had two other attacks of
passed
enlargement
un-
affected. peritonitis, in the last of which several quarts of dark-brown fluid were 1
Lancet, 1891, vol. ii., p. 1040. 14 *
l88
LARGE
removed
OVARIAN
by tapping.
TUMOUR IN YOUNG GIRL.
About six
or seven
weeks after this
under my care, and an ovarian cyst, either or with one cavity greatly predominating, was unilocular
she
came
At the time of
diagnosed. thickened
peritoneum
was
operation, the diseased and recognised. It was found
cyst, owing to strong and I intestines, bladder, &c. stitched the edge of the cyst all round to the edge of the abdominal wound, except at one place, through which I passed a glass drainage-tube into the abdominal cavity. Another was passed into the sac. For many days the impossible
to
numerous
adhesions
remove
the
to
cavities of the abdomen and
sac were
washed out with
The greater part of the sac sloughed removed piecemeal. On the twenty-eighth day
carbolised water. and
was
scarcely any discharge, the wound was almost closed, and the patient was sitting up. Although the result in both these cases was equally satisfactory, they were associated with very different In one, there was a history of a rapidly conditions. without any adhesions; the operation tumour, growing a drop of fluid without was completed finding its way there
was
peritoneal cavity and the wound was closed provision for drainage. In the other, there history of paracentesis, peritonitis, extensive ad-
into the
without any was
a
hesions, and accumulation of fluid in the abdomen. The operation was prolonged, and the outlook seemed hopeless. Every legitimate effort had been made to find a pedicle. The termination of the case affords ground for
condemning the imprudence of rashly interfere with adhesions and it also shows what
can
be
most unfavourable conditions
many operators, who too and lose their patients;
accomplished
in
even
by thorough drainage.
the
CASE OF LARGE
YOUNG
Macpherson
J.
Physician
TUMOUR IN A
OVARIAN GIRL.
Lawrie, M.D., to the
Weymouth
C.M.
Glasg.,
Sanatorium.
C., unmarried, a delicate, fragile girl of 16, was admitted into the Weymouth Sanatorium on the 25th of March, 1892, on account of a gradually increasing enlargement of the abdomen of about two years' duration. Her general health had been fairly good. The menstrual discharge appeared at intervals of about two weeks, and was rather profuse. Her ailment caused her a good deal Elizabeth
of discomfort and
some
pain,
of
and she had become the
in her
unjust suspicion neighbourhood. examination, a large, prominent swelling was found, occupying the greater part of the abdominal cavity and extending up to the ensiform cartilage. The cirobject
On
cumference of the
forty area.
inches. The
the flanks.
body
at the level of the umbilicus was
Fluctuation
was
distinct
over a
considerable
note
was dull, except low down in percussion On vaginal examination, the fundus uteri,
easily defined, was found pushed over towards the left; and, filling up the right half of the pelvis, an irregular hard swelling could be felt continuous with that
not
in the abdomen. The
operation
was
performed in long was
incision about three inches
the usual way. An made in the middle
LARGE
line.
Several arteries
exposed was
OVARIAN
TUMOUR IN YOUNG
up and the cyst was Spencer Wells's trocar
caught
were
without much trouble.
introduced at the most
siderable
quantity
187
GIRL.
prominent part,
of brown fluid evacuated.
and
a
con-
The trocar
withdrawn and the aperture in the cyst enlarged. On introducing my hand, the tumour was found to be in
was
great part solid, and it
important enlarge
was
impossible
reduction in its size.
to
the abdominal
scissors in
an
It
accomplish any became necessary which was done with
incision, upward direction, and
trouble the tumour
was
to
now
after
a
deal of
good
drawn out of the abdomen. the
On
in three
breadth, ligatured pedicle portions and divided. After cleansing the peritoneal cavity, the edges of the wound were brought together account of its
was
eleven silk-worm gut sutures, and the operation completed with a dressing of iodoform gauze. The tumour and its contents weighed over twenty-five pounds.
with
The further progress of the temperature did not rise over
case
The
day
was
At the end of
normal.
found healed and the sutures was
quite
This
well in
case
a
was
and
ioo?,
on
the third
week the wound and the
removed,
fortnight. contrasts strongly
satisfactory. was
patient
a
with that of
a
patient
in the Sanatorium last year, from whom I removed an ovarian tumour, complicated with chronic peritonitis and The patient was a married woman, and the of mother of five children. She 37 years age, had noticed for two years a slowly increasing enlargement of the abdomen. An attack of peritonitis supervened extensive adhesions.1
and
away, leaving the general She had two other attacks of
passed
enlargement
un-
affected. peritonitis, in the last of which several quarts of dark-brown fluid were 1
Lancet, 1891, vol. ii., p. 1040. 14 *
l88
LARGE
removed
OVARIAN
by tapping.
TUMOUR IN YOUNG GIRL.
About six
or seven
weeks after this
under my care, and an ovarian cyst, either or with one cavity greatly predominating, was unilocular
she
came
At the time of
diagnosed. thickened
peritoneum
was
operation, the diseased and recognised. It was found
cyst, owing to strong and I intestines, bladder, &c. stitched the edge of the cyst all round to the edge of the abdominal wound, except at one place, through which I passed a glass drainage-tube into the abdominal cavity. Another was passed into the sac. For many days the impossible
to
numerous
adhesions
remove
the
to
cavities of the abdomen and
sac were
washed out with
The greater part of the sac sloughed removed piecemeal. On the twenty-eighth day
carbolised water. and
was
scarcely any discharge, the wound was almost closed, and the patient was sitting up. Although the result in both these cases was equally satisfactory, they were associated with very different In one, there was a history of a rapidly conditions. without any adhesions; the operation tumour, growing a drop of fluid without was completed finding its way there
was
peritoneal cavity and the wound was closed provision for drainage. In the other, there history of paracentesis, peritonitis, extensive ad-
into the
without any was
a
hesions, and accumulation of fluid in the abdomen. The operation was prolonged, and the outlook seemed hopeless. Every legitimate effort had been made to find a pedicle. The termination of the case affords ground for
condemning the imprudence of rashly interfere with adhesions and it also shows what
can
be
most unfavourable conditions
many operators, who too and lose their patients;
accomplished
in
even
by thorough drainage.
the
