Two cases in which Porro's operation was performed for impacted pelvic tumours preventing delivery / by Mayo Robson.

  • Robson, Arthur William Mayo, Sir, 1853-1933.
Date:
1897
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Licence: Public Domain Mark

Credit: Two cases in which Porro's operation was performed for impacted pelvic tumours preventing delivery / by Mayo Robson. 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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    Reprinted for the Author from the DRmsn Medical Journal,,.. October 2;!ra, 1897. ^^^V '^'-'/iV 1^' / ! '' TWO CASES IN WHICH POIIRO'S |((^jERATiQlS : WAS PERFORMED FOR IMPACTEfe^LVia ; TUMOURS PREVENTING DELI9MY. 5 /^j,^ By Mayo Robson, F.R.C.S., President of the Bi-itish Gynajcological Society, Senior\ui^ebQ^to the- General Infirmary at Leeds, and Professor of SurgeiTjn tha ■ Yorkshire College of the Victoria University. / .'y p <^ C\ The following cases of Porro's operation for obstructi5ll''pss.- duced by tumours present so many points for consideration, that a report of them may, I trust, prove of sufficient interest to waiTant my having brought them to the attention of the Gynaecological Section. Casb I. Pregnane!/ at term : Pelvis completely blocked by suppurating ovarian cyst complicated iviOi a large septic abscess bounded by utenis, ovarian cyst, and intestines: Porro's operation: Recovery of mother and c/«7cZ.—For the notes of the following case I have to thank L>r. RadcUffe Husband, Hon, Sur- geon to the Kipon Hospital, under whose care the patient was. A. W., 24, had always enjoyed good health, began to menstruate when J5, and had been quite regular. She was married in November, 1895. A fortnight after, and following ou a menstrual period, she was seized with sudden and violent pain in the lower part of the abdomen, chiefly at tlie left side. Under rest and treatment this subsided in two or three weeks, and she had had no illness since, menstruating regularly, the last period on May 2nd, 1896. She had a slight appearance of menses on August 2ist, following, but it only lasted two days, since which she had seen nothing, and had been quite well until January i8th, when she began, as she thought, in labour about i p.m., and sent for the midwife, who stayed with her aU night. The following afternoon (January 19th), getting no better. Dr. Collier was sent for, and, after examining her, he asked me (Dr. Husband) to see the case with him. On arriving at the house we found the woman somewhat exhausted and suffering from pain of a periodic nature in the back and body. The abdomen presented all the appearances of normal pregnancy, and the foetal heart could be plainly heard. On examining per vaginam the finger at once came upon a hard round substance very much like the foetal head at full time, well engaged in the cavity of the pelvis as in the second stage of labour; but this it clearly was not, for it was covered by the posterior vaginal wall, and on passing the finger along the front of the tumour, the cervix could with difficulty be reached high up and above the symphysis, and tracing it backwards, the fcetal head was just perceptible through the uterine wall. The os was not in the slightest dilated, and would not admit the finger tip. It was probable that labour had not commenced, and as it seemed impossible that delivery could be accomplished except by ab- dominal section, we gave her morphine to relieve the pain, and recom- mended that she should be removed to the Cottage Hospital. She was taken there the same evening. Gradually the pain disappeared, and slie had no further symptoms until January 30th, when she had a rigor and her temperature went up to 102.6°, but fell the next day to normal. During the next two days she had two more rigors, and on one occasion the temperature was 105°. On the morning of February 2nd she had another severe rigor, passing at that time 15 pint of greenish fluid, but the OS remained undilated, and she had no proper labour pains, though the whole abdomen was swollen, tender, and painful. The fcetal heart could be distinctly heard. Notes of the Opehation. On January 25th 1897,1 received a letter from Dr. Husband, saying that he had a patient advanced in pregnancy whose pelvis was blocked up by a tumour. On January 30th I received a second letter to say, At a consultation of the staff of the hospital this morning it was the wish of everyone thatyou should be asked to come and see the patient, and, if you tliink it ad- visable, perform the operation. On February 2nd 1 went to Kipon, and found the patient, a woman of 23, extremely ill, with a temperature of 103°. She had had a rigor on the 3J8t, and the temperature had readied 105°. The pulse was very rapid, tlie abdomen enormously distended, the face pinched and anxious, and the condition generally extremely unsatisfactory. A pelvic examination revealed a soft tumour present in tlie pelvis, and as high as the linger could reach behind the puhes could be felt the os uteri. The fdital heart