Laceration of the Internal Jugular Vein by a Portion of Fractured Clavicle

J. W. Ogle
1873 BMJ (Clinical Research Edition)  
about six months, during which time she had constantly suffered with severe intermitting pains of a bearing-down nature, together with frequent nausea and vomiting; the bowels had been very costive, with tenesmus coming on at intervals, and sometimes she had had complete retention of urine for some hours ; all these symptoms had become very much aggravated about ten days before I saw her. There were no breastsigns of pregnancy, and she had never felt any movements. A vaginal examination with
more » ... finger revealed the uterus carried high up, and greatly anteverted. The menstrual discharge had been very irregular from the commencement of the symptoms. She was ordered full doses of opium, and a turpentine stupe to be applied over the abdomen. NText day she appeared somewhat better, and I did not see her again till the evening of June 26th, when I found the symptoms, if anything, increased in severity, and she had had some rigors. As no efficient examrlination could be made without the use of chloroform, I determined to olace her under its influence on the following day ; and having done so I was enabled, by the additional evidence thrown on the case, to express a decided opinion that it was one of extrauterine pregnancy ; for not only did the history and symptoms entirely favour this view, but nearly every other possible disease could be excluded. Owinig to the extremely precarious state of the patient, it was thought advisable, before proceeding to operate, that another opinion should be lbad, although the patient and her friends were most anxious that what was necessary should be done at once, notwithstanding only a very slight chance of recovery was held out to them. I was extremely fortunate in obtaining the opinion of my esteemed friend, Dr. Savage, the same afternoon, when he agreed that immediate operation was the proper course. I therefore, in the presence of Mr. Bailey, Dr. Savage, Ar. Priestley Smith, who kindly gave the chloroform, and two others, pei formed gastrotomy. An incision about four inches in length was made in the median line between the umbilicus and the pubes. Dissecting down through the litiea alba, the peritoneum was reached, and opened upon a director, wvhen a quantity of dark blood began to flow from the abdominal cavity. The tumour was now exposed; and, as it was somewhat elastic to the touch, an ovarian trocar, for safety's sake, was thrust into it; but, as rno fluid escaped, I withdrew the instrument, and introduced my finger through the opening it had made, when, to my extreme satisfaction, I found my diagnosis to be correct, as I at once felt the limbs of the fcrtus. Opening the cyst, I removed it by the feet; and, in doing so, found the head lodged deeply in the pelvis. The fcetus weighed about a pound and a half. All blood was removed as completely as possible from the abdominal cavity. Its effusion had been caused by a rupture in the cyst, which no doubt occurred at the time when the symptorns increased in severity-viz., about ten days before I saw her. Tlhe cyst-wall was then stitched to the abdominal parietes, the placenta being left 2tt si/it. A pad of wet lint placed over the wound, covered with terax, and a bandage, completed the operation. The patient was then removed to bed; and a small quantity of brandy was administered, as slhe app2ared faint. She soon, however, became very restless, and in about three hours breathed her last. The next day, I was permitted to examine the parts. I therefore enlarged the abdominal wound, and exposed the cyst, etc. The peritoneum in the right lumbar region was covered with blood, which had evidently been effused for some days. Adhesive inflammation had been set up about the part of the cyst where the rupture had occurred, gluing it to the ascending colon, and slightly to the parietal peritoneum. The omentum was likewise covered in patches with discoloured blood, and was of a greenish cast in nany places. The cyst was found to be connected with the right Fallopian tube, and no trace of an ovary could be found on that side. The uterus was rather enlarged. The ovary, round liganient, and Fallopian tube on the left side, were all healthly. I purpose slhowing the cyst, titerus, and fcetus, at the annual meeting of th.e British Medical Association.
doi:10.1136/bmj.2.656.82-a fatcat:h5ydtlywhjfo7ntnhtvtwphsmm