Clinical papers / by J. Halliday Croom.

  • Croom J. Halliday (John Halliday), Sir, 1847-1923.
Date:
1901
Catalogue details

Licence: In copyright

Credit: Clinical papers / by J. Halliday Croom. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    I'he first case I saw with Ur. JJrysdale of Uimfermliiie. Its history is long ami tedious. Suffice it to say that tlie operation was undertaken, on account of long and continuous lui'inorrhage, and the presence of a tumour in tlie pouch of 1 )ouglas about the size of a large orange. On opening the abdomen and ])ulling the tumour up to tlie surface, it was found to be a suliperitoneal fibi'oid, wliich could be easily dealt with. Tlie pedicle was small and thin, and, having }iassed a needle through it in the usual way, so as to ap]»ly a ligature })revious to removal, and while gently tightening it, the ligature came away in my hands, while the tumour remained in those of my assistant. Naturally I expected alarming hamiorrhage, but there was very little, only a slight oozing from a small denuded surface on the posterior wall. The peritoneum was drawn together over this surface, and the ovaries then being removed, the ojieration was speedily completed. The other similar case occurred in hospital, and was so exactly similar to the foregoing, that I need not repeat the details. The interest of these cases lies in the peculiar nature of the pedicle, and explains how tumours may become completely detached from the uterus. In most cases of subperitoneal fibroids the pedicle is firm and fibrous, and is continuous with the tumour on the one hand and the uterus on the other. In these two cases the fibrous tissue was entirely absent, the pedicle consisting of only two layers of peritoneum, and tni removal the denuded surface of the uterus was quite smooth. It can 1)0 easily understood that a tumour like tins, situate in the pouch of Douglas, would be a considerable time in se])arating; but, had it been free in the abdominal cavity, one can easily imagine that it would drag on the thin vascular peritoneum, interfering with the Idood supply, and ultimately causing se])aration. Such conditions of ])edicle