The vermiform appendix and its diseases / by Howard A. Kelly ... and E. Hurdon ... With 399 original illustrations, some in colors, and 3 lithographic plates.

  • Kelly, Howard A. (Howard Atwood), 1858-1943.
Date:
[1905], [©1905]
Catalogue details

Licence: In copyright

Credit: The vermiform appendix and its diseases / by Howard A. Kelly ... and E. Hurdon ... With 399 original illustrations, some in colors, and 3 lithographic plates. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

    819/898 (page 755)
    has given the impression of a maUgnant neoplasm. The following case is a striking example of the diagnostic difficulties in such cases. J. H. H., Gyn. No. 8751. Negress, age twenty-four. Admitted with a history of pelvic pain, dating from a childbirth two years previously. The pain was drag- ging in character, increased on exertion and relieved by recumbent position. There was a feeling of obstruction on defecation and at times considerable pain; there was also slight bladder irritation. All symptoms had been much worse during the past five or six months. She was well nourished, her tongue clear, temperature and pulse normal. Examination showed the pelvic organs normal except for the retro- posed uterus. In the ileocecal region there was a mass the size of a hen's egg, slightly irregular in outline, of rather firm consistency. The mass could be moved upward away from the pelvic brim, but could also be brought well do^vn into the pelvis on the right side. On opening the abdomen the mass in the ileocecal region was found to involve the head of the cecum; it was about the size of a hen's egg and hard. The appendix was not seen. As the mass strongly suggested a new-growth, extir- pation of the entire affected area was decided upon, and was accordingly done, after which an end-to-end anastomosis was made. Examination of the removed struc- ture showed a retrocecal appendix, surrounded by a mass of dense inflammatory tissue. Similar cases are described by vSonnenburg, Fenger, Gerster and others, and have been cited in Chap. XV. The finding of a distinct tumor in the appendix should always be regarded with suspicion, because innocent tumors are rare; whereas carcinoma is rela- tively common. While it is often impossible to determine the true nature of the growth when it is in situ, it can usually be recognized in the gross specimen by examining the cut surface and noting the relation of the tumor to the appendical walls. In doubtful cases, especially if a wide resection of the bowel is necessary, frozen sections should be examined at once during the operation. Prognosis.—The time which has elapsed since the majority of the cases of carcinoma have been operated on, is too short to permit of a positive state- ment regarding the prognosis. Up to 1900, only 3 cases had been discovered at operation, Beger's in 1882, Stimson's in 1896, and Weir's, reported in 1903. In the first of these, extensive invasion of surrounding structures had taken place at the time of operation. I have not been able to obtain the later historjr of Stimson's case. Weir's patient remained well during the three vears he was under observation. Since 1900, 20 cases have been operated on. All recovered from the operation, and so far as I can learn, with the exception of Rolleston's case, none have shown evidence of recurrence. Some months after operation Rolleston's patient was in poor health and the possibility of a recurrence of the growth was suspected. McBurney, in May, 1903, wrote me that his patient (operated on eighteen months before) was in good health. Thorndike's patient two years after operation gave no evidence of return