On the treatment of hydatid tumours of the liver / by John Harley.

  • Harley, John, 1833-1921.
Date:
[1883]
Catalogue details

Licence: Public Domain Mark

Credit: On the treatment of hydatid tumours of the liver / by John Harley. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    contraction and obliteration of the remaining cavity. I believe that I have now arrived at a perfectly safe and satisfactory method of effecting this result. The following is in brief the treatment which I adopt. Thrust a trocar and canula (the larger the better, but not of less dimensions than a No. 12 catheter) into the most prominent part of the tumour, provided that this be, as usual, in one or other hypochondria, or not very distant from it. Assist the escape of such cysts or broken cyst-membrane as may be protruded by the tension of the parts, by a catheter wire formed into a little hook at the end; retain the canula by threads or tapes attached to holes in its shoulder, and well secured to the surface by strips of adhesive plaster; protect against injury from the edge of the canula by the insertion of an elastic catheter, loosely tied to the canula so as to allow of free play in the respiratory and bodily movements. For the next week nothing more need be done in the generality of cases, beyond the occasional removal of the catheter and the teasing out of such cysts as present themselves at the outer orifice of the canula. A week will suffice under these circum- stances to effect adhesion between the cyst and the abdominal wall, if this have not already occurred, and it is not possible to predicate what the state of the case may have been before tapping. After the lapse of seven or eight-, days, when the patient usually begins to experience uneasiness from a return of the tension of the cyst, or from decomposition of its contents, or both, we should evacuate the contents of the cyst. The canula, which has now become loose by suppuration of the wound, should be removed over an elastic catheter previously introduced into the cyst; then there will be no difficulty in introducing a large catheter by its side, one always being retained within the cyst as a guide. Having thus provided a free passage into the cyst proceed to evacuate its contents. For this purpose, I have had made large (No. 20) elastic catheters, with a lateral eye about one inch long by one eighth of an inch wide. By means of an ordinary brass syringe with a fine nozzle, cyst-membrane is drawn into the eye of the catheter, and while tension is main- tained it is withdrawn, and the cyst thus removed from the sac. By patient and continued repetition of this process, a very large sac may be more or less completely emptied in the course of two or three hours, cyst-membrane of any size and thickness