A case of interilio-abdominal amputation for sarcoma of the ilium, and a synopsis of previously recorded cases : being a report of two clinical lectures delivered at the Jefferson Medical College Hospital, with supplementary remarks / by William W. Keen and J. Chalmers Da Costa.
- William Williams Keen
- Date:
- 1904
Licence: In copyright
Credit: A case of interilio-abdominal amputation for sarcoma of the ilium, and a synopsis of previously recorded cases : being a report of two clinical lectures delivered at the Jefferson Medical College Hospital, with supplementary remarks / by William W. Keen and J. Chalmers Da Costa. 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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![spots marking degeneration. It soon produces infection of adj acent tissues, and at a comparatively early period causes general infection. This is one of the most malignant of all tumors, and is the form of growth which I believe is present in this patient. What part did the injury play in causing the tumor ? Had there been a distinct bruise, we should have attached great importance to it; for a contusion is the frequent antecedent of a sarcoma. It may be that, by a sudden or violent movement, the patient injured the periosteum through muscular traction; and such an injury might be causative quite as well as a contusion. Another supposition is that the tumor had already begun; and that the man injured the region of the tumor or lacerated the muscular fibers around it, rapid growth having followed the injury. It is impossible to say whether the injury caused the sarcoma, or whether it simply hast- ened the growth of an existing tumor. In order to confirm the diagnosis, I now introduce, with every aseptic care, a tubular exploring needle, entering it into one of the softest spots. The point moves with considerable freedom, although not with as much ease as it would if it had entered an abscess cavity. Only blood flows out. I cover the puncture with collodion, send the patient out, and will have the skiagrapher take an x-ray pic- ture. [As this threw no new light upon the case, it is not repro- duced.] Can we do anything for this poor fellow ? If we let him alone, death is inevitable and will come soon; and in order to reach it, he must travel a weary road of pain, sleeplessness, exhaustion, ul- ceration, and hemorrhage. If it were a giant-cell sarcoma, there might be some hope that, if we could remove the tumor and also a part of the ilium, the patient would be benefited; but in a round- cell, or even in a spindle-cell sarcoma, the growth is so disseminated locally that such a procedure would be worse than useless. A chance, and the only chance, is afforded by an operation of the most for- midable nature,—an operation that consists in the removal of the entire lower extremity and a large portion of the pelvis. It has been several times performed with success in Europe; but it has not, I believe, been attempted in this country.1 Professor Keen has been much interested in this operation of late, and has performed it on 1 Later this was found to be an error. See table of cases, page 8. G](https://iiif.wellcomecollection.org/image/b22397103_0012.jp2/full/800%2C/0/default.jpg)
