Operation wounds of the thoracic duct in the neck : with a résumé of the two prior recorded cases and two additional cases / by W.W. Keen.

  • Keen, William W. (William Williams), 1837-1932.
Date:
[1894]
Catalogue details

Licence: Public Domain Mark

Credit: Operation wounds of the thoracic duct in the neck : with a résumé of the two prior recorded cases and two additional cases / 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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    divided for over one-fourth of its circumference. In the next three experiments the duct was cut obliquely. On the following day the dogs were evidently sick, with a rapidly increasing fre- quency of respiration. On the evening of the third or fourth day they died, and at the autopsy the pleural cavity was found full of chyle. The cause of death w'as compression of the heart and lung from effusion of chyle. In the sixth and seventh experiments he placed a canula in'the duct. This was followed by suppurative pleurisy, with death respectively on the fourteenth and tenth days. At the autopsy the pleura was found covered with fibrinous clots, but as the fever had subsided on the fifth day, he ascribed death to the loss of chyle. In the eighth experiment he ligated the ends of the duct in the neck. On the fourth day he inserted his finger into the pleural cavity. The duct was easily found as it was dis- tended with chyle. He wounded it slightly with scissors, and seventy-two hours later the dog was killed. The duct and the receptaculum ^vere distended with chyle, and at the site of the wound a small red fibrinous clot was found. Very little chyle had escaped on account of the smallness of the wound. As a result of his experience he thinks that the complete in- tegrity of the duct for the support of life is not absolutely neces- sary. He gives a uumber of instances of complete obliteration or compression of the duct without any symptoms. The collateral circulation of the lymph seemed to be established, and Schmidt and Mulheim have shown experimentally that the closure of the duct in dogs, in whom the canal is always single, did not affect either the digestion or tlie absorption of albuminous matter. An injury followed by closure of the duct, therefore, is not necessarily fatal. The danger is that if the duct is not closed, either com- pression of the lungs and heart from the constantly augmenting accumulation of chyle in the pleural cavity wdll prove fiital, or that the loss of nourishment will be lethal if it escapes externally. Wounds of the duct seem to be entirely capable of healing. Should the heart and lungs be compressed, clearly the pleural cavity should be opened in order to avoid the immediate danger of death from compression, as is shown by Kirchner's case {Arch, f, klin. Chir., 1885, p. 156). This seems to have been an undoubted and severe rupture of the thoracic duct within the thorax, and yet Avas followed by recovery. It shows that even rupture of the duct may not necessarily be fatal. A little girl, nine years of age, healthy altliough not very strong, was pushed violently against a window-sill, injuring her at the level of the third rib. Marked orthopnoea, with cyanosis and sweating, and dilatation of the nostrils followed in the course of two weeks. The right half of the thorax was broader tlian the left up to the level of the spine of the scapula and the third rib.