A case of associated streptococcus infection of the vermiform appendix and Fallopian tube / by Hunter Robb.

  • Robb, Hunter, 1863-1940.
Date:
1892
Catalogue details

Licence: Public Domain Mark

Credit: A case of associated streptococcus infection of the vermiform appendix and Fallopian tube / by Hunter Robb. 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.

    7/8 (page 7)
    8. Roll agar from exudate in adhesions between loops of small intestines, and uterine stump studded with white colo- nies of streptococcus. In addition there are about twenty or thirty colonies of staphylococcus pyogenes aureus. 9. Roll agar from peritoneal fluid at a distance from pre- ceding, about a dozen colonies of streptococcus showing that peritoneal infection was chiefly confined to the neighborhood of the stump. 10. Slanting agar from surface of loops-of intestines shows no growth. The case is interesting in showing a limitation of streptococcus peritonitis, perhaps due to the absence of the drainage tube. CONCLUSIONS. The case is a very unique and interesting one in several aspects, and suggests many important considerations. First. The unusual condition of pyosalpinx of one side with appendicitis, salpingitis and ovaritis of the opposite side, both the right Fallopian tube and vermiform appendix con- taining the streptococcus pyogenes. Second. The duodenal ulcer as a possible sequela of the cauterization of the pedicles and appendix. The ulcer, though recent, appears to be rather too far advanced to be regarded as due to the operation, and there are no observations which show that gastric or duodenal ulcers follow burns of this character. That the death was immediately due to the henfbrrhage from the ulcer is clearly shoiun by the anaemia of all the tissues, the large amount of blood in the intestines, and the eroded vessel in the ulcer. Third. The presence of the segment of a tape-worm in the intestine and vermiform appendix, which might possibly have acted as a foreign body and had some connection with the appendicitis. Fourth. Although it cannot be definitely stated that the infection extended from the appendix to the tube, the presence of the streptococci in and about the appendix and in the tube on the same side, and its absence in the other tube, speaks for this view. Fifth. It demonstrates the uselessness of a drainage tube in the presence of virulent organisms, which, on the contrary, would diminish the resistance of the tissues and do harm by its presence. In this case it would not have drained, as the greater portion of the purulent fluid was walled off from the peritoneal cavity, the infection being thereby limited, and not of itself producing the fatal issue.