Some cases of abdominal cysts following injury / by Rickman John Godlee.

  • Godlee, Rickman John, Sir, 1849-1925.
Date:
[1887]
Catalogue details

Licence: Public Domain Mark

Credit: Some cases of abdominal cysts following injury / by Rickman John Godlee. 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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    the ribs. The stomach and spleen appeared to be pushed up by it and there was dulness in the left back to the level of the eighth rib. The tumour was quite dull ; the rest of the abdomen was resonant as were the upper part of the left side and the whole of the right side of the chest. On this day (August 12) I drew off with the aspirator, through a puncture between the iliac crest and the ribs, three inches from the spine, 550 c.c. of turbid, slightly alkaline urine containing -3 per cent, urea (total 153 grammes), half albumen, a large quantity of mucus, a small quantity of pus, and some phosphate crystals. The child was not in any way upset by this proceeding, but the cyst rapidly refilled and in two days was about as large as before. The urine passed amounted to 250 c.c. on the 13th, 290 c.c. on the 15th, and 150 c.c. on the 16th, and was normal in character. The temperature remained slightly raised. On the 19th (that is just a montli after the accident) I opened the swelling, making the incision across the puncture previously made. The cyst wall was carefully exposed before opening it and was dense and fibrous, the lining perfectly smooth. The kidney was felt projecting into the upper and anterior part and seemed rough at its lower end; a drainage- tube was inserted and the wound was dressed with salicylic wool, the deeper parts of which were soaked in 1—2000 cor- rosive sublimate solution. The amount of fluid drawn off was 1214 c.c.; it contained •15 per cent, urea, some pus, and y1^ albumen. For three weeks the patient was quite comfortable except for the copious leakage of urine from the wound, which showed no sign of diminution ; the tube had been removed and the cavity and the sinus had both very much contracted. Then began the first of a series of pyrexial attacks, no doubt due to some accumulation of pus and urine in the deeper parts of the wound, which continued off and on till the middle of October. In these, the temperature often rose to 103° or 104° and the child was becoming pale, thin, and pasty-looking. The rein- sertion of a tube had no effect in stopping these attacks. I could not doubt that the ureter was completely ruptured, because no blood had appeared at any time in the urine, and I argued that if the laceration had been in the kidney it would probably by this time have closed. I accordingly thought it best to remove the kidney, and this was done on October 28, through a crucial incision in the loin. The operation was very