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.

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    Operation, Nov. 11th.—Patient prepared as usual; incision in the median line through moderately thick abdominal walls. The Fallopian tube and ovary on left side were adherent to each other, and to the broad ligament and posterior surface of the uterus by dense connective tissue adhesions. The adhesions were so firm that it was impossible to enucleate this mass with- out rupturing the sac, which allowed several drachms of a purulent fluid to escape into the pelvis. Cultures were immediately taken from this escaping fluid. The tube and ovary were transfixed, incised, and the pedicle cauterized. The right Fallopian tube and ovary were separated from the adhesions which bound them to the pelvic wall. The tube was elongated, thickened and patulous at the fimbriated extremity. The ovary on this side was also enlarged, and studded here and there with inflammatory patches from three to six mm. in diameter. The tube and ovary were transfixed and incised after the broad ligament was quilted by a series of silk ligatures and the pedicle cauterized. Before removing the right tube and ovary, the vermiform appendix was examined and found enlarged and adherent to the upper surface of the ovary. This was separated from the ovary; the lower portion for a distance of 2 cm. was congested, thickened and covered with flakes of lymph. The mesappendix was well developed. After transfixing and incising the mesappendix, 4 cm. of the appendix was ligated by a circular suture to avoid pene- trating the lumen of the appendix, which was then burnt off by Paquelin’s cautery. The peritoneal cavity was irrigated with four litres of a sterilized salt solution at a temperature of 112° F., and sponged dry. Owing to the separation of the large adherent surfaces, •slight oozing persisted. The peritoneal cavity was closed by uniting the peritoneum with a continuous cat-gut suture, and the musculo-cutaneous surfaces with silk sutures. No drain- age. Time of operation, fifty minutes. The pulse immediately after the operation was full, regular, and strong. Cultures and smear preparations made from the right Fallo- pian tube and vermiform appendix immediately following the operation were pure cultures of the streptococcus pyogenes. Cul- tures taken during the operation from the pus luhich came from the left tube ivere negative.