Appendicitis in children / by John B. Deaver.

  • Deaver, John B. (John Blair), 1855-1931.
Date:
[1893]
Catalogue details

Licence: Public Domain Mark

Credit: Appendicitis in children / by John B. Deaver. 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.

    19/22
    tions found. When the abscess is circumscribed and shut off, after the pus has been evacuated and the cavity irrigated, if the appendix can not readily be found, it is not judicious to make a prolonged search for it, by which the limiting wall may be broken through and a communication with the general peritonaeum established. In this class of cases, how- ever, I have been fortunate enough in most cases to find the appendix and remove it without breaking through the abscess wall. This is always more satisfactory to the surgeon than to complete the operation by simply draining or packing the abscess cavity, and it removes what may be the cause of one or more attacks of the relapsing variety of the dis- ease. When the abscess is in communication with the gen- eral peritoneal cavity a more prolonged search for the ap- pendix may be made with less risk than in the preceding- state, but the patient’s general condition is usually so bad under these circumstances as to make it unwise to keep him under the effect of the anaesthetic any longer than is absolutely necessary. The points I observe in making the incision for the re- moval of the appendix in acute cases where there is present a mass, be it pus or exudate, are the following: When the loin is rendered prominent by the mass or is the seat of oedema, I take it as an indication that the appendix holds a post-caecal or an external antero lateral position, or that it comes off from the apex of the caecum, and I carry the in- cision parallel with and a short distance above the outer third of Poupart’s ligament, prolonging it outward if neces- sary. When the mass presents itself well to the inner side of the anterior superior spine of the ilium, I carry the in- cision through the semilunar line—rather, through the rec- tus muscle immediately to the inner side of the semilunar line. The wound when carried through the muscle heals more solidly, and therefore there is less likelihood of the