Gastrotomy: large abdominal-uterine tumor, extirpated by John O'Reilly / reported by Richard J. Halton.

  • Halton, Richard J.
Date:
1863
Catalogue details

Licence: Public Domain Mark

Credit: Gastrotomy: large abdominal-uterine tumor, extirpated by John O'Reilly / reported by Richard J. Halton. Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    administered by Mr. James O'Dowd, Dr. O'Reilly, in presence of Drs. Nelson, T. G. Thomas, and myself, commenced the operation. The first incision was carried from the umbilicus to the pubes, and the integuments, muscles, and peritoneum, being divided, the tumor was brought into view, and Dr. O'Reilly made an attempt to introduce a trocar, but without success: he tried in another spot with the like result. Indeed, from its feel, it was evidently solid.; so he prolonged the incision almost to the ensiform cartilage, and now the parietes, contracted at each side, left the tumor exposed. It hid the viscera altogether, and when it came to be lifted out it was found to be attached to the uterus, or rather the uterus was attached to it behind, and the fallopian tubes embraced it on either side. The lateral ligaments were closely attached to it; in fact they formed an all but complete investment, for they stretched out on it apparent- ly as the tumor increased. There was a great deal of difficulty in finding the exact attachments of the tumor, but the principal ones appeared to be from the third to the fourth lumbar verte- bra, and then extending along the sacro-iliac synchondrosis of the right side—how far down in the pelvis may be imagined when I mention the fact that I tied a vessel low down in the recto-uterine space: the attachments were partly torn through with the hand, partly cut. The principal vessel entered the tumor opposite the third lumbar vertebra, and was of con- siderable size ; there were about six smaller ones : each was tied as it was divided ; nevertheless, haemorrhage from the numerous oozing-points was considerable. When the tumor was removed, the abdominal cavity (the lower part of it) was sponged out several times to remove the blood. The edges of the wound were brought together first by a deep me- tallic suture, twisted, embracing the soft parts external to the peritoneum ; and by a common interrupted suture securing the integuments, sticking-plaster being applied in the intervals be- tween the sutures; and finally a towel folded flat, a pad of tow, and a many-tailed bandage, completed the dressing, the two last tails of the bandage being brought down under the thighs, up in front of the groin, and fastened there to guard against any slipping; and then the patient being thoroughly washed, and all traces of blood removed, was carried to bed. She got
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