Clinical Surgery by Case Histories; Diseases of the Abdominal and Genitourinary Organs (Paperback)

This historic book may have numerous typos and missing text. Purchasers can download a free scanned copy of the original book (without typos) from the publisher. Not indexed. Not illustrated. 1921 Excerpt: ...triangle. The legs are not swollen. The reflexes can not be demonstrated. The x-ray of the spine shows nothing. Diagnosis.--The gradual onset of pain in the abdomen with emaciation resulting in the accumulation of fluid filling the right side of the abdomen suggests tuberculosis of the peritoneum. The rounded masses on the left side probably are coils of jejunum thickened by a tuberculous process. The failure of the fluid accumulation to move, it seems likely, is due to a sacculation because of hyperplastic tuberculosis. The exudate is of too long a duration and too widespread to make a perirenal abscess likely, and the leucocytosis is not high enough. The x-ray seems to exclude a tuberculosis of the spine. The fact that the liver is displaced upwards suggests an intraperitoneal exudate which is lifting the liver. A sacculated peritoneal tuberculosis of the right half of the body seems the best diagnosis. Treatment.--A right rectus incision was made. The peritoneal cavity was free from fluid, the omentum and intestinal coils were unaffected. The thickened coils it was supposed that we felt were not in evidence. Beginning at the midline was a bulging, fluctuating mass which lost itself behind the liver above and extended down into the iliac fossa?. It showed no evidence of acute infection. The colon rode on its surface apparently unobstructed, but its vessels were much enlarged. The incision was closed and sealed with collodion. An incision wa's made from the midline of the twelfth rib downwards and inwards. The cndoabdominal fascia bulged and where this was opened great quantities of yellowish odorless pus.rolled out. In this were many white flakes, some of which were as large as a bite of beefsteak. The cavity extended from behind the liver over to well in...