Cystic tumour of the suprarenal body successfully removed by operation : with notes on cases previously published / by Alban H.G. Doran.

  • Doran, Alban H. G. (Alban Henry Griffiths), 1849-1927.
Date:
1908
Catalogue details

Licence: In copyright

Credit: Cystic tumour of the suprarenal body successfully removed by operation : with notes on cases previously published / by Alban H.G. 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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    her again several times ; on the last occasion, which was in 1904, she became deaf in the left ear. History of the Present Illness.—The dyspeptic attacks, which had never ceased entirely, became severe last summer, and to them were added sharp abdominal pains, which were at their worst during the night, and were referred to a lump in the left side. She was under the care of Dr. Alexander Davidson, of Cornwall Road. Condition on Admission.—The patient was fairly well nourished. The abdominal walls were thin, and below the umbilicus-extremely lax, forming a flaccid swelling, tympanitic on percussion. There was no evidence of separation of the recti. A firm, oval body, freely movable, occupied the left loin. When the patient lay in bed it retreated for the greater part under the ribs, its lower portion rotating upwards into the epigastrium. It could be pushed downwards and inwards to the extent of over 3 in., until its lower pole lay below the level of the umbilicus ; when held downwards there was always more or less resonance on per- cussing its anterior surface. The right kidney could not be felt. The urine was repeatedly examined; there was no history of haematuria, and I never found any trace of blood, but there was always a little rather dense mucous deposit; the secretion was scanty—under 25 oz. in twenty- four hours-—and the specific gravity low—as a rule ranging from 1008 to 1022. On October 7 I made a cystoscopic examination of the bladder, with the kind assistance of Mr. Malcolm. The mucous membrane was pale, the right ureteric orifice normal, whilst slightly turbid urine was seen issuing from the orifice of the left ureter. These appearances are worth recording, as they naturally led me to suspect that the left kidney was the seat of the tumour, which was not the case. The tongue was clean, the appetite good and the bowels regular. The pulse was 72, small and regular. The maximum temperature during the first week after admission was 98'8° F. The uterus had undergone senile changes. The menopause was complete by 45. No part of the tumour in the left loin could be pushed down to the level of the pelvic brim. The nature of the tumour was somewhat obscure, and altogether it appeared to be renal. The Operation.—On October 15, 1907,1 removed the tumour, assisted by Dr. William Griffith; Mr. Morley administered the anaesthetic. The patient was .placed in the horizontal position. A vertical incision was made through the left rectus muscle, near its outer border, beginning about 2 in. below the costal cartilages and extending 4 in. downwards, I passed my hand into the peritoneal cavity as far as the right loin; the