Case of Strangulated Femoral Hernia, containing Ovary and Fallopian Tube.-Operation.-Recovery. By WILLARD PARKER, M. D., Pro fessor of Surgery in the College of Physicians and Surgeons, New York. MESSRS. EDITORS: I beg leave to place at your disposal the account of a novel and interesting case which recently fell under my observation. Very truly yours, WILLARD PARKER, M. D. On the 31st of October, 1854, I was called on to visit Miss F in consultation with Dr. W. aged I obtained the following history of the case:- -Miss F 69, had always been in perfect health, except at times she had suffered from dyspepsia, and had been annoyed by a hernia on the right side. This hernia had existed for many years. She had attempted to keep the parts in place by means of a truss, but had failed to accomplish it. The hernia had always been reducible, and she had usually succeeded in replacing the protruded mass. About two years ago, she failed to put the parts back, became sick at the stomach, and called for her family physician; who, after a while, effected a reduction, and she soon became comfortable. The patient had now been suffering for three days; she had nausea and vomiting, but without dejections; the abdomen was flat, skin cool, tongue moist, pulse small, 90 beats in a minute. The tumor was hard, the size of an English walnut, and tender at its neck, under Poupart's ligament. Dr. W. stated, that yesterday he put the patient under the full influence of chloroform, and succeeded by firm pressure in reducing the tumor, but no relief was manifested. On moving or making a slight muscular effort, the swelling reappeared. I thought of "reduction en masse." I now tried taxis, but failed with the force she would allow me to employ. She was then put into a state of profound anesthesia; and I again made trial of reduction. I could push the whole tumor under Poupart's ligament, but it would seem to bound back. It was now decided to operate. I cut down, and exposed the falciform process of the fascia lata, divided it freely, and then attempted to reduce, without opening the sac, but could not succeed. I could push sac and all up. I proceeded to open the sac : it contained some dark fluid and a small loop of intestine, which was also dark, but not gangrenous. In attempting to explore the neck of the sac with the finger, it receded; and to prevent it from slipping back into the abdomen beyond my reach, I passed a tenaculum into the sac, and gave it in charge of an assistant. The neck was very firm around the strangulated parts, and seemed not more than half an inch in diameter. I divided it freely, and drew down the intestine that I might understand the condition of it; finding all right, the loop was restored. I found something left behind that was dark, shreddy, and vascular, adherent by a small band to the side of the sac. I saw it was not omentum, and concluded it might be the product of some former inflammation. I concluded to dissect away the mass; it bled, and I carried a ligature around the whole When I drew upon the ligature, there came into view the ovary this demonstrated to my mind that the strange portion I had taken away, was the fimbriated extremity of the fallopian tube. I pushed back the ovary and the remainder of the tube, brought the parts together by suture, applied the graduated compress with the single spica bandage. The patient was put and kept fully under the influence of morphine. After four days an enema was administered, and the bowels were moved. A rapid recovery ensued. In consulting authorities in regard to this anomaly, I find no parallel case; but Dr. G. F. Elliot has furnished me with a case from the Gazette Médicale, for February, 1843, in which the Cæsarean section was performed upon the uterus, occupying a hernial sac. "Patient was 44 years old, mother of seven children, had suffered for many years from a reducible inguinal hernia of right side, which during her previous pregnancies had caused her great annoyance. At the sixth month of her eighth pregnancy, the hernia became strangulated, but by emollient and cold applications it was reduced, followed, however, by severe abdominal pains. Soon after, the uterus suddenly presented at the inguinal ring, in the hernial sac, forming a tumor of 8 inches in length by 6 in circumference. The patient remained in bed, and went on to the full term. Labor commenced, the os dilated, and the waters escaped per vaginam; the tumor at the time being twenty-five inches in circumference by twenty-three in length. The Cæsarean section was then practiced, dividing the sac and uterine wall; the placenta presenting, the operator introduced his hand and delivered a well-formed living infant. Patient died on the third day after, of peritonitis or hæmorrhage. On postmortem, there was a large quantity of blood in the abdominal cavity; the inguinal canal was so dilated that the open hand could easily be introduced, and the colon was found detached, and filling the cavity of the sac." The editor of the Gazette severely censures the conduct of the operator in not reducing the uterus when it first escaped, as might have been done; and also in not waiting longer than three hours before performing the section-a complete hysterocele being not incompatible with the spontaneous termination of labor. I find also that Mr. Velpeau, in the second volume of his Traité des Accouchements, mentions a case by M. Saxtorph, in which the uterus at term occupied a femoral hernia, and was spontaneously delivered. In another case by Frank, the uterus protruded through the linea alba. Flamant cites a case complicating umbilical hernia. Case of Spontaneous Rupture of the Bladder-Extravasation of Urine into the Cellular Tissue between the Bladder and Walls of Abdomen -Operation-Recovery. By A. V. WILLIAMS, M. D., late Physician-in-Chief to Ward's Island Hospital, &c., &c WILLIAM Maccullah, aged 32 years, a man of spare habit of body, but of great endurance, has for several years labored under stricture of the urethra, with frequent desire to urinate from irritability of the blad |
