Some cases illustrating the surgery of the spleen / by D'Arcy Power.
- Power, D'Arcy, 1855-1941.
- Date:
- [1908?]
Licence: In copyright
Credit: Some cases illustrating the surgery of the spleen / by D'Arcy Power. 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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![vomited twice. Ilis pulse became much worse at 6.30 a.m., and it remained imperceptible all day until 5 p.m. He theii rallied; his pulse could be counted as beating 130, and his colour ini])roved. He was ordered an enema, with good result, and he passed much llatus. ' 1 saw him for the first time at 2 p.m. on May 14—forty hours after the accident. He was still collapsed, with a rigid and tender abdomen. It appeared evident that he was suffering from severe abdominal injury, and 1 determined, therefore, to make an exploration at all risks. Blood issued from the peri- toneal cavity as soon as it was opened, and a very short exami- nation was sufficient to show that the left lobe of the liver was torn but had stopped bleeding. The intestines were clearly uninjured, and nothing wrong could be felt with either kidney ; but in exploring the left kidney the spleen was found to be badly lacerated. It was drawn up into the wound, and was then seen to be so entirely torn across at the hilurn as to be only attached to the body by a thread of the gastro-splenic omentum. All bleeding had stopped, and subsequent exami- nation of the spleen showed that many of the vessels were thrombosed. The lacerated pedicle was trimmed up, a few ligatures were applied, several ounces of blood-clot were re- moved from the peritoneal cavity, more especially in the left iliac region, a drainage tube was inserted, and the wound was closed. The patient recovered slowly from his state of collapse, the tube was removed on the fifth day after the operation, and was followed by a wholly uneventful convalescence, the boy being discharged from the hospital on June 26—less than six weeks from the date of the accident. These cases bear out the general knowledge that the operation of removing the spleen may be undertaken with good prospect of success, and the patient may afterwards lead a useful and happy life for many years. Van verts in 1897 (These de doctoral, Paris, 1897, and Glazette des Hopitaux, 1898, p. 245) collected the records of 247 cases of splenectomy, from which it appeared that no less than 170 of the patients had recovered. The immediate danger attending the operation lies in the haemorrhage and in the number of adhesions rather than in the shock. The numerous and thin-walled veins are liable to be torn if they are treated roughly; but the operation presents no difficulties greater than those to which we are accustomed in the removal of an ovarian tumour or a hysterectomy. The three cases of ruptured spleen were interesting, because](https://iiif.wellcomecollection.org/image/b22419299_0014.jp2/full/800%2C/0/default.jpg)
