Two cases of laparo-elytrotomy : with remarks / by Charles Jewett.

  • Jewett, Charles, 1839-1910.
Date:
1885
Catalogue details

Licence: Public Domain Mark

Credit: Two cases of laparo-elytrotomy : with remarks / by Charles Jewett. 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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    Some difficulty was experienced in identifying the peritoneum, owing to a considerable degree of old inflammatory thicken- ing, and the peritoneum was snipped through at one point. The minute opening was immediately closed with a ligature. Before the vagina was reached it was found that the head had sunk down into the brim of the lesser pelvis. This situa- tion of the head greatly embarrassed the approach to the vagi- nal wall. Dr. Skene pushed the wall of the vagina up into the wound on the handle of a male urethral sound. A small in- cision was made with the scissors and extended by lacerating with the fingers in a direction parallel with the pelvic brim. The right wall of the cervix was hooked up into the wound with the finger. Version was then attempted, but was found impracticable. The forceps, however, was finally applied to the head after some delay, but not until Dr. Dickinson had lifted it above the pelvic brim with the hand in the vagina. The delivery was completed thirty-five minutes from the begin- ning of the operation, and the placenta was expelled soon after. The child was a male of 5f pounds. The operation was well borne, with but slight shock. The total blood-loss did not exceed the usual amount in normal labor. No vessels were tied. An injection thrown into the bladder returned through the vagina. On examination, the edges of the vesico-vaginal tear could be felt extending obliquely down to the base of the bladder through its margin and then turning abruptly across the urethra just below the vesical junction. The length of the bladder wound was about one inch and a half. The external wound was closed with seven sutures of subli- mated silk. A double soft-rubber drainage-tube was passed through the inner angle of the wound, emerging at the vulva, and a dressing of absorbent cotton applied. A soft catheter was tied in the bladder and the rent left unsutured. In the course of the night the patient was seized with sec- ondary hemorrhage, and lay for hours in an almost moribund condition. The bleeding was finally controlled, however, by pressure over the external wound, and the subsequent improve- ment was uninterrupted except by great tympanitic distention of the abdomen and by occasional rise of temperature. The tympanites did not yield to medicinal remedies nor the use of