Case of fibro-sarcoma or 'desmoid growth' of the abdominal wall / by Alban Doran.

  • Doran, Alban H. G. (Alban Henry Griffiths), 1849-1927.
Date:
[1891]
Catalogue details

Licence: Public Domain Mark

Credit: Case of fibro-sarcoma or 'desmoid growth' of the abdominal wall / by Alban Doran. 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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    near the spine of the pubes for a hernia is an error both natural and probable. On the other hand, it is not very likely that even a student would diagnose a small growth near the iliac spine as a hernia. Patients, however, are often very inaccurate in localising origins of tumours ; this is particularly the case in ovarian cystic disease, which is often described as first appearing in the groin, even when the surgeon himself has examined the tumour in its earlier stages, and noted that it first rose into the hypogastrium. The truss was worn for eighteen months, then a chemist examined the patient, and said that there was a tumour. She became pregnant, and was advised to go to the Samaritan Hospital after the birth of her child. The child had just been weaned when she was admitted under my care. The patient had no evidence of any visceral disease. On July 12th, 1890, I operated. I divided the integuments in the long axis of the tumour; the incision, therefore, ran almost parallel to Poupart’s ligament. The aponeurosis of the external oblique muscle was thus exposed. On dividing it, in the line of the skin wound, the tumour was laid bare. The outermost part was readily raised up. The muscular tissue of the internal oblique and the transversalis fascia ran into the inner part of the tumour and were incorporated with its posterior aspect. On cutting the tumour away from its attachments, the peritoneum was exposed, but not opened. Two small vessels on its surface were wounded and ligatured. The aponeurosis of the external oblique adhered very firmly to the blunt inner extremity of the tumour, but I succeeded in dis- secting it back. The superficial epigastric artery was tied and divided. Then I found that this end of the tumour was incor- porated with the conjoined tendon and the sheath of the rectus, extending to the anterior part of that muscle. After cutting away the tumour, I trimmed away the outer border of the sheath of the rectus and part of the conjoined tendon, which contained hard, circumscribed deposit. The wound was united by silkworm-gut sutures, passed through the skin, subcutaneous tissue, aponeurosis of the external oblique, substance of the internal oblique, and transversalis fascia on both sides of the wound. The skin near the outer extremity was united by a horsehair suture, and a drainage tube was passed into the inner angle. The patient made a good recovery. The wound,