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Avulsion of appendix through uterine perforation
j-13
THE
AXEEKICAhi
.JOI~RNAT~
OF
ORSTETRliS
ANP
GYA’ECOLOGY
periencrd in the diagnosis of perforations presumably made lay another physician. In regard to therapy, E’romme is of the opinion that in all doubtful hut probable perforations an esploratorqlaparotomv ot’ ant.erior colpotomy should be performed. Every diagnosed perforation must be subjected to prompt treatment which in the majority of the cases Tvill be opera.tive. 0nly iu the case of the aseptic, perforation vith the sound is conserratism permissible. All statistics prove the advantage of operative interference over coneer~ative measures. The conditions in each individnal instance will determine the particular nature of the. operation required, especially in regard to the nccessit,y or ad-\-isahility of removing the entire uterus. In the last part of this paper the writer consiclers the legal responsihility of the physician in such cases of uterine perforation under German lav-s.
Braude : Avulsion
of Appendix through Uterine Perforation. Zeitschrift fiir C:elml+hiilfe und CrynSkologie~ 1914, lssv, 780. A patient, mother of four children7 dnring the fourth month of her The consultefl physician made fifth pregnancy complained of chills. the diagnosis of abortion and decided to empty the uterus. Failing vith the curette. he resorted to the forceps and recognized in the first portion of tissue extracted a. torn off appendix. Prompted hp the severe hemorrhage he thoroughly cnretted and irrigated the uterus and then “not to lose any time,” himself brought. the patient in a. carriage to the clinic. M%rn seen l)>- Braude, the patient was slightly anemic and had a goocl pulse of 80. The abdomen, especially on the right side was somewhat tencler to pressure. Laparotomp was immediately performed, not quite tvo hours after the curettage. The small intestinw showed three perforations, which n-ere closed hy suture. A small piece of appendix still on the cecum was remo\-ed in typical manner. The cecum vas almost completely denuded of its serosa, and was COT-cred as well as possible. Several ligatures were placed around hematomas in tlip mesenter\-. In the post,erior cu1desa.c a, portion of the fetal vertebtaal cnlumn wa.s discovered. In T-iew of the evident infection the uterus was extirpakd. Xuch to Braude’s surprise the patient passed, without any symptom of peritonitis, through a satisfactory con~nlescence and \\-as discharged well on the twenty-third day after operation. Williams, John T.: Accidental Perforation of the Uterus during Curettage, with Laceration of the Small Intestines. Journal American &\ledical Assncia.tion, 1919, lssiii, 1361. Patient., aged tv-enty-seven, had several miscarriages. Wassermann 4.plus. She v-as curetted in her home by a local ph>-sician for a miscarriage in the fourth month of prepnanc~. He perforated the uterus and drew clo~~i a loop of intestines. tearlng it completely across hefore he rralizecl vhat he bad done. Vhen admitted to the Boston City Hospital seTera inches of Iacrratecl intestines were protruding from vagina. Immediate iaparotomy showed the ileum completel: torn through. its proximal portion separated from its mesentery for about 12 inches;. This portion of the ileum ~vas resected and an end-to
THE
AXEEKICAhi
.JOI~RNAT~
OF
ORSTETRliS
ANP
GYA’ECOLOGY
periencrd in the diagnosis of perforations presumably made lay another physician. In regard to therapy, E’romme is of the opinion that in all doubtful hut probable perforations an esploratorqlaparotomv ot’ ant.erior colpotomy should be performed. Every diagnosed perforation must be subjected to prompt treatment which in the majority of the cases Tvill be opera.tive. 0nly iu the case of the aseptic, perforation vith the sound is conserratism permissible. All statistics prove the advantage of operative interference over coneer~ative measures. The conditions in each individnal instance will determine the particular nature of the. operation required, especially in regard to the nccessit,y or ad-\-isahility of removing the entire uterus. In the last part of this paper the writer consiclers the legal responsihility of the physician in such cases of uterine perforation under German lav-s.
Braude : Avulsion
of Appendix through Uterine Perforation. Zeitschrift fiir C:elml+hiilfe und CrynSkologie~ 1914, lssv, 780. A patient, mother of four children7 dnring the fourth month of her The consultefl physician made fifth pregnancy complained of chills. the diagnosis of abortion and decided to empty the uterus. Failing vith the curette. he resorted to the forceps and recognized in the first portion of tissue extracted a. torn off appendix. Prompted hp the severe hemorrhage he thoroughly cnretted and irrigated the uterus and then “not to lose any time,” himself brought. the patient in a. carriage to the clinic. M%rn seen l)>- Braude, the patient was slightly anemic and had a goocl pulse of 80. The abdomen, especially on the right side was somewhat tencler to pressure. Laparotomp was immediately performed, not quite tvo hours after the curettage. The small intestinw showed three perforations, which n-ere closed hy suture. A small piece of appendix still on the cecum was remo\-ed in typical manner. The cecum vas almost completely denuded of its serosa, and was COT-cred as well as possible. Several ligatures were placed around hematomas in tlip mesenter\-. In the post,erior cu1desa.c a, portion of the fetal vertebtaal cnlumn wa.s discovered. In T-iew of the evident infection the uterus was extirpakd. Xuch to Braude’s surprise the patient passed, without any symptom of peritonitis, through a satisfactory con~nlescence and \\-as discharged well on the twenty-third day after operation. Williams, John T.: Accidental Perforation of the Uterus during Curettage, with Laceration of the Small Intestines. Journal American &\ledical Assncia.tion, 1919, lssiii, 1361. Patient., aged tv-enty-seven, had several miscarriages. Wassermann 4.plus. She v-as curetted in her home by a local ph>-sician for a miscarriage in the fourth month of prepnanc~. He perforated the uterus and drew clo~~i a loop of intestines. tearlng it completely across hefore he rralizecl vhat he bad done. Vhen admitted to the Boston City Hospital seTera inches of Iacrratecl intestines were protruding from vagina. Immediate iaparotomy showed the ileum completel: torn through. its proximal portion separated from its mesentery for about 12 inches;. This portion of the ileum ~vas resected and an end-to