Umbilical hernia, operation, cure : ligation of femoral artery for popliteal aneurism, cure : fecal fistula caused by appendicitis, operation, cure : a clinical lecture delivered at the Jefferson Medical College Hospital, April 6, 1892 / by W.W. Keen.
- William Williams Keen
- Date:
- 1892
Licence: Public Domain Mark
Credit: Umbilical hernia, operation, cure : ligation of femoral artery for popliteal aneurism, cure : fecal fistula caused by appendicitis, operation, cure : a clinical lecture delivered at the Jefferson Medical College Hospital, April 6, 1892 / by W.W. Keen. 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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![IO described, without having even seen the vein, and with very little mechanical disturbance of the sheath. The operation is done, but the case is not yet cured. These are two very different things. For at least ten days after I have tied the femoral artery I am anxious. At the end of this time the parts have become so con- solidated that there is little risk of secondary hemor- rhage. There is also a possibility that gangrene may follow the cutting off of so large a portion of the blood- supply of the leg. The limb will be enveloped in cotton, and surrounded by hot-water bags, in order to keep up the heat of the part, and so tend to prevent gangrene. [Note.—Recovery was immediate and complete. On the sixth day after ligation pulsation was detected in the dorsalis pedis artery, through the collateral circulation. In October, 1892, the aneurism was still cured, and he was at work.] Case III. Fecal fistula following an abscess from appendicitis; operation; cure.—The next case is one of unusual interest and probably of unusual difficulty. It is that of the young man whom I showed you a week ago with a fecal fistula in the right loin. I propose to make an incision and trace the fistula to its source, but after we get a large wound with possibly a small opening at the mouth of the fistula, the question arises in my mind, If I cannot easily see this fistula, how shall I follow it ? In order to overcome this difficulty, I have provided a bag filled with hydrogen, and if I find difficulty in fol- lowing the sinus I shall inflate the colon through the rectum and note where the gas bubbles into the wound. Air would answer just as well, but hydrogen being lighter, will escape more readily. The patient states that on March 20, 1891, he had an attack of appendicitis. A large swelling formed in the right iliac region and rapidly extended upward and backward into the lumbar region. Ten days later it was opened to the right of the first lumbar spine, when](https://iiif.wellcomecollection.org/image/b22313631_0014.jp2/full/800%2C/0/default.jpg)
