The management of accidental puncture and other injuries of the gravid uterus, as complications of laparotomy / by Charles Carroll Lee.

  • Lee, Charles Carroll, 1838-
Date:
1883
Catalogue details

Licence: Public Domain Mark

Credit: The management of accidental puncture and other injuries of the gravid uterus, as complications of laparotomy / by Charles Carroll Lee. 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.

    6/18 (page 4)
    hemorrhage, and the abdominal wound was closed. Toward evening the patient was seized with pain, and aborted, the child and placenta coming away together. This did not produce much shock or depression, although she was feeble. Next day she was free from pain and perfectly quiet. In the evening she felt quite comfortable, but during the night she sank rapidly and died. No autopsy was permitted. Case III.—In September, 1865, Sir Spencer Wells performed ovariotomy in a case where pregnancy was overlooked. A multilocular cyst weighing twenty-eight pounds was removed from the left ovary, and then another supposed cyst of the right ovary was discovered ; this was tapped, and, after three pints of bloody fluid had escaped, was found to be the gravid uterus. On withdrawing the trocar, a bleeding mass protruded ; and, upon introducing the finger to push this back and exam- ine the cavity, the uterine wall, which was friable and soft as if from fatty degeneration, at once gave way and a quantity of liquor amnii, with a five months’ fetus, escaped ; the pla- centa was then easily peeled off from its uterine attachment. There was moderate hemorrhage, and, as the womb did not contract, a free opening was made by passing the finger down through the cervix and os ; then a piece of ice was put into the cavity and held by firmly grasping the organ upon it. This effected contraction, and the uterine wound was closed with a continuous silk suture. Thirty-three days later the patient was discharged well, and was still in good health in 1881. A full account of this remarkable case may be found in the Medical Times and Gazette for September 30,1865. In a more recent review of this case, the distinguished author alludes to two other cases in which the same mistake was made by other surgeons, who did not empty the uterus, but closed the puncture in its wall by wire sutures, both patients having died after aborting. No names or references are given. He concludes from this record that, in all cases where the operator has penetrated the uterus, the safer prac- tice will be to empty the womb by Cesarean section, and either to close the opening with sutures, or to perform supra-