Surgery of the rectum and pelvis / by Charles B. Kelsey.

  • Kelsey, Charles B. (Charles Boyd), 1850-1917
Date:
1898
Catalogue details

Licence: Public Domain Mark

Credit: Surgery of the rectum and pelvis / by Charles B. Kelsey. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

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    It will occasionally happen that a secondary abscess will form in these cases at a point not far removed from the original, and due to failure to clean out and remove some septic focus. This will be shown by a rise of temperature coming on after a longer or shorter period of convalescence. No connection with the original focus may be discoverable. When such rise of temperature occurs the wound should be re- opened, and search made for the new abscess. Finally, there remains to be considered the class of cases in which the septic peritonitis is diffuse and not localized. These will be quickly recognized when the peritoneum is incised by the escape of pus and serum, with, perhaps, gas and fseces. The wound should first be enlarged sufficiently to allow free access of the hand to all parts of the peritoneum. The patient should be turned on the side and all fluid allowed to flow out that will do so. Next localized collections of pus are to be searched for with the hand and evacuated. The appendix is to be removed or its stum]) properly treated. The whole peritoneal cavity should then be flooded again and again with hot saline solution till all flocculi aii' washed away, and Douglas' pouch is finally wiped dry with sponges in holders. The drainage should be as thorough as possible, and different strips of gauze should reach to different parts of the abdomen. In women, a posterior colpotomy is often advisable to allow of escape of fluids into the vagina. The incision should be left open for at least three or four inches, and the gauze should be loosened at the end of the first twelve hours to see that there is no obstruction to the flow of fluid. These cases, although generally fatal, are not necessarily so, and operation should never be refused, unless the patient be in articulo mortis. There are many cases of recovery even from this desperate condition as a result of proper surgical treatment.