The surgery of the subperitoneal tissue : read in the Section of Surgery, at the Annual Meeting of the British Medical Association in Carlisle, July, 1896 / by William Anderson.

  • Anderson, William, 1842-1900.
Date:
1896
Catalogue details

Licence: Public Domain Mark

Credit: The surgery of the subperitoneal tissue : read in the Section of Surgery, at the Annual Meeting of the British Medical Association in Carlisle, July, 1896 / by William Anderson. 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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    l(i with the knife. These tumours, whatever their origin, may attain remarkable dimensions. In a case published by Deguise,the growth was as large as a man’s head, in others under Brossard,^‘ Koch,*’ Eeclus,*® and Hue,” the weight ranged from 3 to ii pounds, and Wilms is said to have extir- pated a monster of 19^ pounds. In Hue’s case the tumour weighed ii pounds, and the patient was obliged to carry his scrotum in a bag suspended around his neck. The mixed tumours may reach even a greater size. Karew- ski** successfully excised a lipoma containing fibrous, myxomatous, and sarcomatous elements weighing nearly 20 pounds (8,950 grammes). Before the operation the patient found it necessary to rest the tumour upon the ground before taking a seat, lest the mass should make him slip from the chair. As a rule, however, the growths come under treatment while they are of small dimensions, and are often mistaken for hernias until operation is undertaken. Their diagnosis, indeed, is frequently of some difficulty, but they may usually be recognised by their physical characters, their history, and their imperfect reducibility. The excision of the tumours rarely oflTers any diflBculty unless, as in Eeclus’s case, already referred to, fatty tissue is dispersed amidst the elements of the cord. A peritoneal tube must, however, be carefully sought for and dealt with. The result of the operation, apart from failures of antisepsis, is favourable, even in the largest growths, but the probability of recurrence must be borne in mind. Curling ** and Langen- beck have described examples of this, and in a case of ray own the removal was effected twice, and the patient subsequently developed a third lipoma with an enterocele. A failure of antisepsis may be serious owing to the continuity of the growth with the subperitoneal tissue. Kocher speaks of one case in which fatal septicaemia followed, and refers to a case of Tizzoni’s which was followed by tetanus. Severe heemoiThage and injury to the vas have occurred, but are, of course, accidents within the control of the surgeon. The femoral lipomata have attracted less attention than those in the inguinal region, and are somewhat more rare. They are more common in women, but a case in a male sub- ject was recorded by myself in 1893,here a hernial sac was found in the root of the tumour. The mesial lipomata in the linea alba are, perhaps, the most frequent. These, like the inguinal and femoral varieties, may simulate omental hernia very closely, and usually con- tain a serous pouch, but occasionally, as in a specimen in the museum of St. Thomas’s Hospital, may reach a considerable size without leading to any peritoneal change. They are liable to cause troublesome symptoms, which are often diffi- cult to explain. In the past three months I have had two children under my care at St. Thomas’s Hospital who were brought by their friends on account of the pain and occasional attacks of vomiting induced by little fatty protrusions 85 Bull, et M6m. Soc. de Chir., 1859, p. sag. 8< Arch. Gin. de Mid., 1884, vol. ii, pp. 367,1308. 85 Deutsche. Zdisch.J. Chir., 1890, p. 391. 88 Loe. cit. 8’ Bull. Soc. de Chinirfj., 1893. p. 63. 88 Abstract in Sem. Midicate, 189s, p. 314. 89 Tram. Path. Soc., r868, p. w Lancet, 1893, vol. ii, p. 930. 81 Loc. cit.;