On ovarian dropsy : with cases of ovariotomy / by Thomas Keith.

  • Thomas Keith
Date:
1863
Catalogue details

Licence: Public Domain Mark

Credit: On ovarian dropsy : with cases of ovariotomy / by Thomas Keith. Source: Wellcome Collection.

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    different occasions, I still did not feel satisfied, till one day, about six weeks ago, when I put the patient upon her knees, and making pressure upon the roof of the vagina, I seemed to have dislocated the pelvic portion of the tumour from its position, for the uterus was now felt to be quite free and movable, and the vagina lost at once the hard tight feeling it had so long maintained. Soon after this, she had a most severe attack of pain in the tumour, accom¬ panied by great irritation of the rectum, and excessive vomiting, which continued for nearly a week. This attack was followed by acute painful oedema of the right leg; and as this subsided, there was swelling of the vagina and lower part of the abdominal wall, and ascitic fluid began to collect rapidly in the cavity of the peri¬ toneum. As this accumulated, it became evident that adhesions, which had been supposed to be present over the anterior surface of the tumour, did not exist, and there was a corresponding im¬ provement in the feeling of the uterus and upper part of the vagina, and I was satisfied, as well as were several of my friends who had examined this case, and in whose judgment I had great confidence, that the body of the uterus was free from any attachment. I had intended, before this ascitic fluid had made its appearance, to have emptied a cyst of considerable size on the right side, which dipped into the pelvis, in order to assist the diagnosis ; but as that now seemed clear, I was unwilling to put my patient to the slight additional risk of doing so, and I began the operation in hopes that this tumour, which I had so long looked upon as one most difficult of removal, would in reality be taken away quite easily. After exposing the tumour and allowing the ascitic fluid to escape, it was found that the tumour so filled up the pelvis, that it was necessary to empty the various cysts before the pelvic cavity could be examined by the hand. About three gallons were col¬ lected, and both ovaries were found to be diseased. The left was composed of a single cyst, and extended upwards under the ribs. It was tapped and drawn out, and its pedicle, which was the longest I ever met with, was secured. The uterus was small, but movable in all directions, and free from adhesion. On proceeding to remove the right ovary, it was found to have no pedicle. The tumour arose about an inch from the uterus, the broad ligament suddenly expanding in all directions, enclosing within its folds an immense thick mass of dense sarcomatous substance, out of which arose the large cysts composing the tumour, and the entire removal of which was evidently impossible. After due consideration, it was thought the better practice to remove as much of the mass as possible, instead of abandoning the operation altogether, by returning the now emptied and partly broken-down cysts. The cyst-walls were, moreover, exceedingly vascular, and had been punctured in many places, and were bleeding freely; and it was out of the question to cut off* the mass, in hopes of' being able to tie the vessels singly. A strong twine ligature was first passed through it; but, from the
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