On complete intra-peritoneal ligature of the pedicle in ovariotomy / by Alban Doran.
- Doran, Alban H. G. (Alban Henry Griffiths), 1849-1927
- Date:
- [1877]
Licence: Public Domain Mark
Credit: On complete intra-peritoneal ligature of the pedicle in ovariotomy / by Alban 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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![Case I. \ A. F., 61. Removal of the left ovary for cystic disease; death on the fourth day. Pedicle of the left ovary very tightly ligatured Ly transfixion p congested and sloughy in parts, hut adherent to the broad liga- ment by recent lymph deposited along its outer and posterior border. Ulceration at several points from pressure of the ligature. An adhesion between the tumour and the sigmoid flexure had been separated during the operation. This adhesion was old and well organised, and left on the bowel a raw surface the area of a halfpenny, where the muscular coat was exposed. At this spot the calibre of the intestine was diminished to a diameter of under a quarter of an inch. The walls of the bowel at the seat of obstruction were inflamed and thickened. There was no other morbid appearance in the body. Was the cause of death to be traced to the treatment of the pedicle or to the intestinal lesion ? Both probably took a share in the fatal result. It is always possible that the operator may pull the ligature so tightly as to cause sloughing before certain well-known salutary changes can save the stum]) of the pedicle. The absence of a covering of organised coagulum, so often observed on the cut surface of the stump, is significant; in con- sidering Case X. more will he said on this subject. The surgeon cannot invariably calculate the exact amount of force necessary, in any given case, to ensure against haemorrhage without the induction of gangrene. On the other hand, the pedicle, not cut so long as to be free at its margin from vascular influence, had become adherent posteriorly to the broad ligament. This favourable pathological change suggests that the less favourable congestion and the actual sloughing of parts of the stump had been secondary. Now the condition of the sigmoid flexure of the colon represented morbid influences quite sufficient to destroy an old patient exhausted by suffering followed by a capital operation. These influences possibly induced the sloughing of isolated spots on the pedicle after the establishment of the favourable adhesive changes. Hence this case does not severely reflect on intra-peritoneal ligature, which might have had a very small share, if indeed it took any part at all, in the fatal result. Case II. Mrs. P., 36. Death twenty-six hours after the removal of a large cystic tumour of the right ovary. 1 In all tlie cases here described silk was used for that purpose.](https://iiif.wellcomecollection.org/image/b22454937_0020.jp2/full/800%2C/0/default.jpg)
