AMRITSAR CIVIL HOSPITAL. OP AN OVARIAN CYSTIC SUCCESSFULLY REMOVED BY
A BRIEF ACCOUNT
TUMOUR
OVARIOTOMY. By Mulchand, Assistant Surgeon, Amritsar.
Musst. Kishan Dai, Hindu female, aged 20, resident of Amritsar, was admitted into this Hospital on 8th July. Reported to have always enjoyed good health previously ; of rigidly temperate habits, and leading a sedentary life. She was married when 11 years of age, and the menses made their appearance six months subsequently, and remained, regular for about three years. Her husband is alive- Wlieu 14 years old she conceived, and had a miscarriage at about the 7tli month; the child lived for an hour or two; the menses re-appeared, and remained regular for about two years, when she conceived for the second time, and gave birth to a male child, who is alive and with her. After this she remained quite well durino15 mouths, but the menses never re-appeared, was no trouble or pain experienced by their after this a small Soon stoppage. swelling of the size of an egg was noticed in the rio-ht iliac region, which gradually increased in size till there was a general fulness of the abdomen.
THE INDIAN MEDICAL GAZETTE.
382
first suspected, but after was at she consulted the Lady months of 10 expiry Superintendent of the Maternity Hospital, who tapped and removed about 8 ounces of fluid from the abdomen. This having given no relief, she consulted a Native Doctor nine days after, who again tapped, but the abdomen did not return to its natural size. Within a month the operation was repeated by the same Hospital Assistant. On 8th June, three months after, she came to the Civil Hospital, and was tapped by me, and a large quantity of thick gelatinous fluid was removed, and much solid tumour which remained was very distinctly felt on palpation iu the right iliac
Pregnancy
the
region.
On 8th July she came in again ; the circumference of the abdomen measured 5' x 4', and very tense. She was much emaciated, features sunken, unable to walk, and dejected in spirits ; iu fact, There was she was nothing but a skeleton. puffiness of the face and hands ; the legs and feet were oedematous ; face pale ; features contracted ; fluctuation distinct; and the percussion note was not influenced by change of position ; was very restless, and much troubled by dyspnoea. She consented to undergo the operation of ovariotomy, which had been advised by BrigadeSurgeon J. C. Penny, M.D., Civil Surgeon, Amritsar. On the 9th July the operation-room of phenyle, was carefully washed with solution and on the 10th, from 6 o'clock in the morning to 9 a.m., the room was disinfected by antiseptic spray. The patient was as usual prepared by a purgative at night and an enema in the morning. After careful ablution of the hands, an incision of about four inches was made in the skin from the navel downwards to an inch from the pubic bone in the line of the linea alba. Next the muscular and other structures a were very carefully divided on director, till the peritoneum was reached and carefully divided ; the tumour bulged out with a small quantity of fluid. It was fixed by the vulsellum forceps, and tapped with a long trocar and canula. On passing the hand into the cavity of the abdomen, the tumour was found to be adherent on all sides, and was separated by the fingers with great difficulty, especially the adhesions in the neighbourhood of the liver. This done, the tumour was removed in two masses. On my introducing the hand again, I found another tumour in the left iliac region, though smaller than the other two. This was also similarly separated aud removed. All three were connected by a large dense empty sac, and had one long pedicle in the right iliac region, which Mas tied with a strong catgut ligature and divided and returned into the abdominal cavity, which was carefully dried with sponges. was
[Dec.,
1885.
The peritoneal edges were scrupulously brought together by catgut ligatures, and the skin brought into careful apposition. The wound was dressed with pure iodoform, carbolic oil-
gauze and tow, and all was enveloped in a broad abdominal bandage. The tumour was composed of three large loculi, each being filled with a large quantity of gelatinous purulent fluid and number of smaller cysts. The tumour weighed 6 fbs, and the fluid removed, measured several pints. Stimulant with a small quantity of opium administered, and ice and milk ordered. No inconvenience of any kind was experienced during the operation. The next morning she was found to be happy and cheerful; had passed urine thrice, and had taken 1^ seer of milk, and did not complain of any pain or discomfort. The temprature rose to 101? in the evening. On t he 11th, she passed the whole day with restlessness,slight pain, and great weakness with thready pulse; but the opium, stimulants, and ice with nourishment kept her up, when on the morning of the 12th the temperature went down to 99?. On the 14th, the wound was opened under antiseptic spray, and upper two-thirds found to be united by first intention. The lower third was covered with a small quantity of matter which was cleaned off, and the whole dressed antiseptically and bandaged up. On 17th, the wound dressed again as previously under antiseptic spray, and the patient kept well all the time ; was fed by milk, sago, and soup; she passed a hard motion during the
night.
On 18th, the wound was dressed again, and a little matter issued from the edges at the lower part of the wound; therefore the wound was ordered to be dressed daily. She passed ordinary motions once a day ; sutures removed from the upper part of the wound that had completely united. The temperature had remained normal all this time from the 12th. On 22nd, the patient suddenly complained of severe pain in the head, her pulse getting weak, and ull signs of exhaustion were setting in: but by giving ice, together with effervescent draught The and Spt. Am. Arom., she came round. remaining sutures were removed, as the wound had completely closed. 31st.?The patient was quite well; wouud wholly healed, and the patient took her discharge successfully cured. Remarks. of the patient. state 1. Hopeless 2. Obscure extent of the tumour. 3. Adhesions of the tumour in the neighbourhood of the liver distinctly felt after the tapping previous to the operation. 4. Surgical appliances such as could be
extemporised. 5.
II em ark ably easy recovery.
A BRIEF ACCOUNT
TUMOUR
OVARIOTOMY. By Mulchand, Assistant Surgeon, Amritsar.
Musst. Kishan Dai, Hindu female, aged 20, resident of Amritsar, was admitted into this Hospital on 8th July. Reported to have always enjoyed good health previously ; of rigidly temperate habits, and leading a sedentary life. She was married when 11 years of age, and the menses made their appearance six months subsequently, and remained, regular for about three years. Her husband is alive- Wlieu 14 years old she conceived, and had a miscarriage at about the 7tli month; the child lived for an hour or two; the menses re-appeared, and remained regular for about two years, when she conceived for the second time, and gave birth to a male child, who is alive and with her. After this she remained quite well durino15 mouths, but the menses never re-appeared, was no trouble or pain experienced by their after this a small Soon stoppage. swelling of the size of an egg was noticed in the rio-ht iliac region, which gradually increased in size till there was a general fulness of the abdomen.
THE INDIAN MEDICAL GAZETTE.
382
first suspected, but after was at she consulted the Lady months of 10 expiry Superintendent of the Maternity Hospital, who tapped and removed about 8 ounces of fluid from the abdomen. This having given no relief, she consulted a Native Doctor nine days after, who again tapped, but the abdomen did not return to its natural size. Within a month the operation was repeated by the same Hospital Assistant. On 8th June, three months after, she came to the Civil Hospital, and was tapped by me, and a large quantity of thick gelatinous fluid was removed, and much solid tumour which remained was very distinctly felt on palpation iu the right iliac
Pregnancy
the
region.
On 8th July she came in again ; the circumference of the abdomen measured 5' x 4', and very tense. She was much emaciated, features sunken, unable to walk, and dejected in spirits ; iu fact, There was she was nothing but a skeleton. puffiness of the face and hands ; the legs and feet were oedematous ; face pale ; features contracted ; fluctuation distinct; and the percussion note was not influenced by change of position ; was very restless, and much troubled by dyspnoea. She consented to undergo the operation of ovariotomy, which had been advised by BrigadeSurgeon J. C. Penny, M.D., Civil Surgeon, Amritsar. On the 9th July the operation-room of phenyle, was carefully washed with solution and on the 10th, from 6 o'clock in the morning to 9 a.m., the room was disinfected by antiseptic spray. The patient was as usual prepared by a purgative at night and an enema in the morning. After careful ablution of the hands, an incision of about four inches was made in the skin from the navel downwards to an inch from the pubic bone in the line of the linea alba. Next the muscular and other structures a were very carefully divided on director, till the peritoneum was reached and carefully divided ; the tumour bulged out with a small quantity of fluid. It was fixed by the vulsellum forceps, and tapped with a long trocar and canula. On passing the hand into the cavity of the abdomen, the tumour was found to be adherent on all sides, and was separated by the fingers with great difficulty, especially the adhesions in the neighbourhood of the liver. This done, the tumour was removed in two masses. On my introducing the hand again, I found another tumour in the left iliac region, though smaller than the other two. This was also similarly separated aud removed. All three were connected by a large dense empty sac, and had one long pedicle in the right iliac region, which Mas tied with a strong catgut ligature and divided and returned into the abdominal cavity, which was carefully dried with sponges. was
[Dec.,
1885.
The peritoneal edges were scrupulously brought together by catgut ligatures, and the skin brought into careful apposition. The wound was dressed with pure iodoform, carbolic oil-
gauze and tow, and all was enveloped in a broad abdominal bandage. The tumour was composed of three large loculi, each being filled with a large quantity of gelatinous purulent fluid and number of smaller cysts. The tumour weighed 6 fbs, and the fluid removed, measured several pints. Stimulant with a small quantity of opium administered, and ice and milk ordered. No inconvenience of any kind was experienced during the operation. The next morning she was found to be happy and cheerful; had passed urine thrice, and had taken 1^ seer of milk, and did not complain of any pain or discomfort. The temprature rose to 101? in the evening. On t he 11th, she passed the whole day with restlessness,slight pain, and great weakness with thready pulse; but the opium, stimulants, and ice with nourishment kept her up, when on the morning of the 12th the temperature went down to 99?. On the 14th, the wound was opened under antiseptic spray, and upper two-thirds found to be united by first intention. The lower third was covered with a small quantity of matter which was cleaned off, and the whole dressed antiseptically and bandaged up. On 17th, the wound dressed again as previously under antiseptic spray, and the patient kept well all the time ; was fed by milk, sago, and soup; she passed a hard motion during the
night.
On 18th, the wound was dressed again, and a little matter issued from the edges at the lower part of the wound; therefore the wound was ordered to be dressed daily. She passed ordinary motions once a day ; sutures removed from the upper part of the wound that had completely united. The temperature had remained normal all this time from the 12th. On 22nd, the patient suddenly complained of severe pain in the head, her pulse getting weak, and ull signs of exhaustion were setting in: but by giving ice, together with effervescent draught The and Spt. Am. Arom., she came round. remaining sutures were removed, as the wound had completely closed. 31st.?The patient was quite well; wouud wholly healed, and the patient took her discharge successfully cured. Remarks. of the patient. state 1. Hopeless 2. Obscure extent of the tumour. 3. Adhesions of the tumour in the neighbourhood of the liver distinctly felt after the tapping previous to the operation. 4. Surgical appliances such as could be
extemporised. 5.
II em ark ably easy recovery.
