File:Interstate medical journal (1919) (14577647057).jpg

Identifier: interstatemedica2619unse (find matches)
Title: Interstate medical journal
Year: 1919 (1910s)
Authors:
Subjects: Medicine
Publisher: St. Louis, : Interstate Medical Journal
Contributing Library: The College of Physicians of Philadelphia Historical Medical Library
Digitizing Sponsor: The College of Physicians of Philadelphia and the National Endowment for the Humanities

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ostal margin thanbetween the umbilicus and the symphysis, but this may have beenmore apparent than real. I am sorry that I had not heard the paperof McLean1 at the time of the operation, so that I could have deter-mined whether the stretching of the abdominal wall was just belowthe semi-lunar folds of Douglas, as he claims it always is in pen- 1The Extreme Pendulous Abdomen and Its Surgical Treatment by a NewThree-Flap Operation. Neil John McLean (Western Surgical Association Trans-actions, page 49). Collins: Large Ovarian Cyst 103 dulous abdomens. Of course, this was an unusual case of pen-dulous abdomen. She also had a goiter, which can be seen in thepicture. It had now been twenty-five years since the patient had firstnoticed the tumor, and she was tired of carrying it and was willingto have it removed. While we expected dense adhesions, the removalof the large tumor would probably not present very many specialdifficulties, but how to get rid of the large pendulous abdominal fi 111
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Fig. 2.—Before operation. Front view. wall was a special problem. Evidently the usual longitudinal in-cision would not suffice. The day before the operation the abdominalwall was punctured with a trocar at three points. The first removeda very thick muddy fluid, and the other two a thick clear fluid.Evidently the cyst was multilocular. About 8 gallons of fluid wereremoved, which reduced the bulk of the tumor and made it a littleeasier to handle. Operation.—September 19, 1917. A hypodermic of scopolamin 104 INTERSTATE MEDICAL JOURNAL 1/100 gr. and morphine 1/6 gr. was administered one hour beforethe operation in addition to her habitual dose of morphine. Theanesthetic was gas and oxygen preliminary to ether by the openmethod. A transverse incision was made from the crest of oneilium to the other through the skin and fat (Fig. 2). The skinand fat were dissected from the aponeurosis below the incision for4 inches. The attenuated aponeurosis, muscle, and peritoneum werethen cut transv

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