A case of post-rectal dermoid, removed by the parasacral route : with remarks on tumours of the sacro-coccygeal region / by Henry Rutherfurd, M.B., F.F.P. & S.G., Assistant Surgeon, Glasgow Royal Infirmary.

  • Rutherfurd, Henry
Date:
[1900]
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Licence: In copyright

Credit: A case of post-rectal dermoid, removed by the parasacral route : with remarks on tumours of the sacro-coccygeal region / by Henry Rutherfurd, M.B., F.F.P. & S.G., Assistant Surgeon, Glasgow Royal Infirmary. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    xxi., p. 307 ; Clntton, Trans. Path. Soc., xxxvii., p. 2o2; Daiizel, Lawjenheclv s Archiv, Jkl. xvii., S. 442.) In the last-men- tioned case the tumour, whicli was carefully described, was evidently complex in structure. It was removed from a woman 25 years of age, and is said to have contained brain- substance and bone, besides bearing on its surface hair and a tooth, 'fhe patient died three months after the operation, of what is described as a local peritonitis. The operation was done after dilatation of the anus, and was evidently a severe one, contrasting with what is required when such a tumour is pedunculated. The case reminds us that rectal dermoids are not always pedunculated. “ The removal of pedunculated open dermoids of the rectum,” says Senn {Tumours, 2nd ed., p. 650) “offers no difliculties; on the contrary, the extirpation of perirectal tumours requires often a formidable operation. Usually the difliculties of oper- ative removal are increased l)y inflammation and suppuration, which render the dissection tedious and difficult.” He refers to “ a case of post-rectal dermoid which had suppurated and ruptured just below the coccyx. . . . There was found an opening large enough to admit three fingers, lined by skin and leading to a cavity the size of a child’s head lined by hairy skin. Decision was against interference . . . the writer could hardly imagine how such a cavity could be made to heal after dissecting out the entire sac.” Such a case is narrated in detail by Deahna {Archiv fur GynaekoL, Bd. vii., S. 305). The patient was a girl of 18, who suddenly developed a tumour in the lower abdomen with pressure on the rectum and retention of urine. The lower wall of the cyst was felt between the rectum and sacrum, the upper impinged on tlie abdominal wall between the umbilicus and symphysis. Exploratory puncture per rectum was followed by suppuration and acute distension, resulting in sloughing of tlie soft parts including vaginal wall and urethra, analogous, as is pointed out by the writer, to what takes place in protracted labour, from pressure of the foetal head. Here also the jxatient, who was under the care of Czerny, had to be dismissed relieved of tlie pressure symptoms but with an open cyst cavity. Trzebitzky {IfGoicr Mcdicin. Woclinischrift, 1885, p. 393)
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