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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    desmoid tumours of the abdominal walls, together with the sub- jacent peritoneum. In one case (Sanger, loc. cit.), after dissecting up a flap of integument, the lower part of the tumour was also raised, by an incision below it into the peritoneum. That mem- brane being found to be inseparable, an aneurysm-needle, armed with a double silk ligature, was passed through the peritoneum and aponeurosis which were to be divided, and brought out again through the same tissues, about an inch further on. A similar transfixion was made an inch external to the former. The process was continued until two complete chains of ligatures were formed, for the ends of the ligatures were tied after transfixion, as in an ovarian pedicle. After each inner and outer transfixion and liga- ture of the threads, the peritoneum between the inner and outer threads was divided. Thus, wheD the chains of ligature were complete, the tumour and its peritoneum and aponeurosis were cut away, and there was no loss of blood, either from the tumour during removal, or from the edges of the huge wound in the abdominal wall. By a complicated system of sutures, the integu- mental flap, including the more superficial layers of the parietes, was fastened down to the edges of the great wound, which were already approximated by silver sutures made fast to plates. Sutures were passed across the flap so as to unite its deep surfaces as much as possible. Thus a stout pad was formed, resisting hernia, instead of a mere bag of skin, into which three-quarters of the abdominal viscera would ultimately have prolapsed.* Several drainage tubes were passed across and along the wound. The patient, in this case, did well. In different cases of large tumours of the abdominal wound, the procedure must vary. The double chain of ligatures, to anticipate haemorrhage, is a good idea, but plenty of pressure forceps, such as most British operators possess, will allow the surgeon to dis- pense with the inner chain. The formation of a good stout pad of integument is an excellent principle. The apposition of a raw flap of integument to the viscera, in place of the parietal peritoneum, appears perfectly justifiable and free from any danger of adhesions, as long as the surgeon takes antiseptic or “ aseptic ” precautions. Dr. Kelterborn, of Dorpat, has recently shown that the stripping off of peritoneum is not # These complicated manipulations are demonstrated in the fine drawings illustrating Dr. Edward Ill’s monograph (loc. cit.).