- Email: [email protected]
Instruments left in the peritoneal cavity
440
THE AMERICAN JOURNAL OF OBSTE'fRICS AND GYNECOLOGY
the operation and independent conditions in about equal proportions. The risk iR greater after operations for inflammatory disease of the tubes, and after unilateral operations of the tubes and ovaries. Cases where operations for malignant disease have taken place must bo regarded as bad life risks. After operations for inflammatory disease th<> expectation of life is fairly good, but is impaired by the liability of sequelae. Patients who have had benign tumors removed may be considered as good life riskR, aR the chance of complications whirh may lead to a fatal rrsult, is negligiblr. NORMAN
F'.
l\lfiLLRI:.
White, 0.: Instruments Left in the Peritoneal Cavity. The Clinical Journal, Lon· don, 1923, Iii, 553. The case reported is that of a won1an o:f fifty teferreJ because her doctor founU a sharp pointed body in the cervix. She had consulted the physician because of acute pelvic pain. Nineteen years previously an abdominal operation had been performed for an abdominal tumor. Eighteen m(>nths before tho author saw her a second operation had been performed to relieve symptoms but the patient was told that the adhesions were too dense to allow anything extensive to be done. The author removed a hemostat whose points had eroded the uterus above the bladder reflexion and the handles had eroded tho pelvic colon and were in thn cavity of t:he gut. She died some six weeks later from an attack seemingly of anaphylactic origin. In a second case the writer removed a bone penholder from the peritoneal cavity whieJh had been introduced through the vagina and rcmaine·d in the cavity about ninety hours. Recovery was uneventful. A canvass of the surgeons of Great Britain showed that there were forty·fonr cases of this type who had been operated with eleven deaths. Among the thirty· three patients who recovered, the foreign body had remained in the peritoneal cavity up to 7, 12, 15 and 19 years. Twenty-six were treated by second opera· tion, an
A. C.
WILLIAMSON.
Chifolia.u: The Operative Risk in SUigical Treatment of Uterine ribroids, L<· Progres Medical, 1924, No. 42, p. 002. The conclusions of this paper are based on the rcHults of all operations for fibroid tumor of the uterus performed by the author during the last twenty years. The cases are divided into two groups, those from 1904 to 1914, and those from 1919 to 1924. In the first group there wore 145 cases with a mortality of 1:3.7 per cent while in the seeond there was a mortality of lrss than 1 per eent in ] !1-J. cases operated. Of the twenty deaths occurring during the first period, 1:1 were dne to infection, 5 to embolism, 1 to hemorrhage, and 1 to chloroform anesthesia. The hemorrhage occurred following the removal of hemostats on the third day after a vaginal hysterectomy. In this connection Chifoliau points out the necessity for great precaution, believing that it should be done in the operating room and with g<;od vaginal exposure so that the pedicles may be reclamped if necessary.
THE AMERICAN JOURNAL OF OBSTE'fRICS AND GYNECOLOGY
the operation and independent conditions in about equal proportions. The risk iR greater after operations for inflammatory disease of the tubes, and after unilateral operations of the tubes and ovaries. Cases where operations for malignant disease have taken place must bo regarded as bad life risks. After operations for inflammatory disease th<> expectation of life is fairly good, but is impaired by the liability of sequelae. Patients who have had benign tumors removed may be considered as good life riskR, aR the chance of complications whirh may lead to a fatal rrsult, is negligiblr. NORMAN
F'.
l\lfiLLRI:.
White, 0.: Instruments Left in the Peritoneal Cavity. The Clinical Journal, Lon· don, 1923, Iii, 553. The case reported is that of a won1an o:f fifty teferreJ because her doctor founU a sharp pointed body in the cervix. She had consulted the physician because of acute pelvic pain. Nineteen years previously an abdominal operation had been performed for an abdominal tumor. Eighteen m(>nths before tho author saw her a second operation had been performed to relieve symptoms but the patient was told that the adhesions were too dense to allow anything extensive to be done. The author removed a hemostat whose points had eroded the uterus above the bladder reflexion and the handles had eroded tho pelvic colon and were in thn cavity of t:he gut. She died some six weeks later from an attack seemingly of anaphylactic origin. In a second case the writer removed a bone penholder from the peritoneal cavity whieJh had been introduced through the vagina and rcmaine·d in the cavity about ninety hours. Recovery was uneventful. A canvass of the surgeons of Great Britain showed that there were forty·fonr cases of this type who had been operated with eleven deaths. Among the thirty· three patients who recovered, the foreign body had remained in the peritoneal cavity up to 7, 12, 15 and 19 years. Twenty-six were treated by second opera· tion, an
A. C.
WILLIAMSON.
Chifolia.u: The Operative Risk in SUigical Treatment of Uterine ribroids, L<· Progres Medical, 1924, No. 42, p. 002. The conclusions of this paper are based on the rcHults of all operations for fibroid tumor of the uterus performed by the author during the last twenty years. The cases are divided into two groups, those from 1904 to 1914, and those from 1919 to 1924. In the first group there wore 145 cases with a mortality of 1:3.7 per cent while in the seeond there was a mortality of lrss than 1 per eent in ] !1-J. cases operated. Of the twenty deaths occurring during the first period, 1:1 were dne to infection, 5 to embolism, 1 to hemorrhage, and 1 to chloroform anesthesia. The hemorrhage occurred following the removal of hemostats on the third day after a vaginal hysterectomy. In this connection Chifoliau points out the necessity for great precaution, believing that it should be done in the operating room and with g<;od vaginal exposure so that the pedicles may be reclamped if necessary.