Ligature of the external iliac artery, followed by secondary haemorrhage / by James R. Wood ; reported by Geo. Amerman.

  • James Rushmore Wood
Date:
[1857?]
Catalogue details

Licence: Public Domain Mark

Credit: Ligature of the external iliac artery, followed by secondary haemorrhage / by James R. Wood ; reported by Geo. Amerman. 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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    Scarpa's space. Pulsation of this tumor was distinctly perceptible to both the sense of touch and sight, particularly the former. This pulsa- tion was felt in every part of the tumor, from the commencement. For the first nine days it grew rapidly, subsequently its growth became much slower. He has never suffered any pain, numbness, or swelling, in the limb since he first observed it. There was no discoloration of the integument, no increase or diminution in temperature. Five weeks after he first noticed it, Deo. 7th, 1855, he was admitted into Bellevue Hospital, under charge of Dr. Jas. R. Wood. At the time of his admission his general health was good. The tumor was situated on its anterior aspect at the junction of the middle with the upper third of the thigh. It was five and a-half inches in its longitudinal, and six inches in .its transverse diameter. An equable pulsation was felt in every part of its surface, synchronous with the arterial pulse. Pressure on the cardiac side caused a diminution in size, and total disappearance of the pulsation. Pressure on the distal side caused an increase in size. A bruit de souflet distinctly audi- ble in every part of it,—no thrill. Diagnosis.—Femoral Aneurism. Treatment.—Ligation of external iliac artery. The artery was tied above Poupartrs ligament, in consequence of the large size of the tumor, and also the inflammatory exudation that had taken place about it, and consolidated the parts. On the 8th day of December, the operation was performed by Dr. Wood, in the presence of several eminent surgeons of this city, and a large class of students. No anaesthetic was given, as it was thought the vomiting and retching, which so often follow their use might be injurious, by causing too great an amount of pressure on the abdominal viscera. The patient was placed upon the operating table, with his thigh slightly flexed. The external incision commenced over the external abdominal ring, one half inch above, and wa£ carried along the course of Poupart's ligament in a semi-circular direction, with its convexity downwards, and terminating one inch above and within the anterior superior spinous process of the ilium. The abdominal layers were next divided; the transversalis fascia reached, and the finger passed into the internal ring ; the fascia was then detached from the peritone- um; the separation began at the internal opening, where it was least adherent, and with the finger for a director, the remainder was divided. The peritoneum was then pushed aside, and held out of the way by an assistant with snatulte ; this brought the vessel in full view; the sheath
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