The significance of pain in the right iliac fossa in young women.

  • Winslow, Randolph (Professor)
Date:
1914
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Licence: In copyright

Credit: The significance of pain in the right iliac fossa in young women. 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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    abdominal conditions. This occurs more frequently in children than in adults, and may occur in either sex. The onset of typhoid fever is sometimes attended with pain in the right side, tenderness, rigidity and elevation of temperature and may closely simulate appendicitis. One may be easily deceived in such cases, and during the past summer I made this error and removed the appendix of a young girl who had typhoid fever. She made an uninterrupted recovery, but l am still chagrined at the mistaken diagnosis. Since beginning to write this paper I have read the lecture by Dr. John B. Murphy on this subject, and he lays down the axiom that fever always precedes pain in typhoid fever, while pain always precedes fever in appendicitis. Whether early pregnancy can produce attacks simulating appendicitis I do not know, but I have recently had under my care a young lady two months pregnant, who had severe pain and tenderness in the right iliac fossa. She was told by a surgeon in New York that she had appendicitis and required an immediate operation. She did not accept his advice and some time later consulted me. I discovered her pregnancy, but thought it best to remove the appendix in order to forestall any appendical trouble during parturition. She went home after my examination, which was entirely an external one, and was compelled to remain in bed several days on account of pain. She returned later and I removed her appendix, which appeared to be normal. Her gall bladder was normal, as were her pelvic organs, except for the pregnancy. She made an uninterrupted recovery without interference with the course of the pregnancy, but I do not know what caused the severe pain in the right side. The abdominal crises of tabes may also delude us in certain cases. I have had one case in a woman in which laparotomy was done, without finding any disease of the abdominal organs; and subsequently the evidence of tabes became pronounced.