Fibromyoma of mesentery, 30 lb. : removal, recovery : with notes on the surgery of retroperitoneal tumours : contribution to a discussion in the Section of Surgery at the Annual Meeting of the British Medical Association, Oxford, July, 1904 / by Alban Doran.

  • Doran, Alban H. G. (Alban Henry Griffiths), 1849-1927.
Date:
1904
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Licence: In copyright

Credit: Fibromyoma of mesentery, 30 lb. : removal, recovery : with notes on the surgery of retroperitoneal tumours : contribution to a discussion in the Section of Surgery at the Annual Meeting of the British Medical Association, Oxford, July, 1904 / by Alban Doran. 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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    9 attributed to haemorrhage; but the patient was anaemic already, and the amount of blood actually lost seemed trifling. The patient’s condition improved when the peritoneal cavity was flushed with saline solution, whilst at the same time Mr. Morley poured some ether into the mask as a stimulant with good effect. I still practise flushing in cases where shock and haemorrhage are unavoidable ; because a method has been abused and over-rated that is no reason why it should be dis- carded where experience had shown that it is beneficial. Towards the end of the operation the shock recurred, and a hypodermic injection of 8 minims of liquor strychninae was given, whilst the abdominal cavity was again flushed. The patient revived. Mr. Morley laid stress on the pre- liminary administration of ether in cases where big tumours are removed, as he finds that it involves less likelihood of cardiac failure from shock than if chloroform alone be used. The removal of a solid tumour of greatweight, though much less bulky than many lipomas and cysts, in itself involved disturbance to the circulation, but fortunately the connective tissue, which alone bound the tumour to the surrounding parts, was uniformly loose and soft, so that traction on adja- cent viscera, nerves, and blood vessels wa3 but trifling, else the shock would have been greater. As in all cases where I undertake the removal of a large abdominal growth, I administered liquor strychninae to the patient for several days before the operation, and for over a week afterwards. This line of treatment has already been advocated by Dr. W. Duncan in the Lancet (vol. i, 1900, p. 1114). I find the results most satisfactory. One or two modern authorities appear to object to the drug. I admit that in operations where the patient is strong, and there is more danger from sepsis than from pure shock, strychnine little of is value, if not absolutely deleterious. In the table, death was ascribed to shock in No. 3, whilst in the remaining three fatal cases (Nos. 2, 6, and 7) it is certain that this complication was not the cause of the fatal result. But the chances of fatal shock are much higher when a lipoma of the mesentery is removed (Terrier, author). This factor renders a correct estimate of the dangers and mortality of resection of intestine impossible, as the procedure in itself may involve shock, whilst that complication in several cases where intestine was removed seemed most probably due to enucleation of the tumour from densely adherent surrounding tissues, with almost unavoidable loss of blood. Enucleation,—In my own case the tumour was shelled out of its capsule of mesentery with ease. Care was taken to work the swabs and forceps and scissors, as well as the finger, close against the tumour, so as to leave the main vessels in the capsule as little disturbed as possible. All branches from the vessels running into the tumour were secured with pres- sure forceps before division, and tied afterwards. Posteriorly several vessels could not be treated in this manner; they were inadvertently divided, but easily recognized and secured as they spouted. It is instructive to compare this case (No. 13) with the remaining 12 in the table. In 3 (Nos. 3, 8, and 13) the tumour was invested by the anterior or superior layer of mesentery alone. In 8 (Nos. 2. 4, 6, 7, 9, 10, n,and 12) both layers of mesentery were opened up; whilst in 2 (Nos. 1 and c) the nature of the encapsulation is not clearly specified. There can be little doubt of two facts: first, that as a rule both