The surgery of blood-cysts of the suprarenal body / by Alban Doran.

  • Doran, Alban H. G. (Alban Henry Griffiths), 1849-1927
Date:
1908
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Licence: In copyright

Credit: The surgery of blood-cysts of the suprarenal body / 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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    vomiting. A tumor was discovered in the left hypochondrium. It was exposed through a median incision, opened, emptied of 1,600 grams of brown fluid, and drained; the cyst-wall sutured to the edges of the abdominal wound, the sutures cut through. The cyst receded, and the patient died of peritonitis. The tumor was found, on post-mortem exam- ination, to replace the left suprarenal body, and its walls contained adrenal tissue. That case is instructive, as it shows the danger of applying sutures to the wall of a tumor of this kind. The tissue is very soft, and weakened by the application of sutures. Of course, the operator had not the advan- tage of the previous experience of others. Pawlik’s is worth quoting, on account of a clear history of injury-. A woman, aged forty, came under his care for a large, elastic, fluctuating tumor in the left side of the abdomen. Two years previously she had fallen from a ladder. Pawlik removed the cyst by enucleation, leaving a small piece of its wall on a kind of pedicle, close to the vertebral column. He found the kidney on the inner side of the lower pole of the cyst. The wall Of the cyst contained islets of adrenal tissue, and a small portion of the suprarenal body itself unaltered. There were seventeen pints of bloody fluid in its cavity. The patient recovered. The seventh case of blood cyst was reported by Triepcke and Bier. A woman, aged sixty-nine, was admitted into hospital, with a tumor of the size of an adult head, filling the right side of the abdomen. It was exposed and tapped; three and one-half pints of turbid fluid, with coagulated blood, came away. The inner wall of the cyst, seeming very unhealthy, was curetted and the cavity drained. The patient died of “shock.” After death, it was found that the cyst was easily enucleable. It occupied the place of the right suprarenal capsule, and adrenal elements were discovered in its wall. The right kidney was displaced downwards, lying in the right iliac fossa. Unfortunately, the original and full report of this interesting- case is not very accessible. It is otherwise with Henschen’s good mono- graph on Struma sup emails cystica hemorrhagica, the name which he ap- plies to these blood cysts of the suprarenal body, which will be found in the forty-ninth volume (1906) of the “Beitrage zur klinischen Chirurgie.” The whole subject is well reviewed, and all cystic diseases of the organ in question taken into consideration. Henschen includes an original case where Kronlein operated. The clinical history is complete in the extreme. The patient was a woman, aged forty-one, subject to attacks of pain in the left hypochondrium for twenty years, beginning with an attack of pleurisy. A big, tense, smooth tumor was detected by her doctor when consulted for an attack of rheumatism. It pushed the lower ribs outwards. Kronlein tapped the left pleura, and much chocolate-colored fluid came away; then he boldly operated through an oblique abdominal incision, and succeeded in enucleating a big cyst, which also contained chocolate-colored fluid. He had to separate the cyst-wall from adhesions at the diaphragm and tail of
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