Aneurism of the abdominal aorta suc cessfully treated by introduction of silver wire into the sac. A trocar was intro duced into the sac, and not much blood issued. Five feet of silver wire were in troduced without difficulty. The punct ure was secured with a silk ligature. There was some vomiting and a good deal of restlessness after the operation. A month later consolidation was occur ring. The after-progress was uneventful. There is at the present time a hard mass in the middle line much smaller than before the operation, and the thrill and bruit have disappeared. Her health was excellent. John Langton (Treatment, May 25, '99).
Case of ligature of the abdominal aorta just below the diaphragm in aneu rism of the upper part of that vessel, the patient surviving forty-eight days. The patient was a laboring man, 52 years old, probably with a syphilitic history, for whom it was first proposed to employ wiring and electrolysis, should an ex ploratory section show its feasibility. The patient, however, left the hospital, only to return five days later with the symptoms of a severe internal hemor rhage. An exploratory section revealed an enormous retroperitoneal lilematoma communicating with the aneurism, and the incision was closed. Repeated injec tions of a 2-per-cent. solution of gelatin were given, and, the patient's condition improving, a second operation was per formed thirteen days later. The omen tum was torn through, and with a long handled pedicle needle four strands of floss silk were carried from left to right under the aorta and near the diaphragm. The silk was disengaged from the eye of the needle with great difficulty and was tied. Immediately the head, face, and neck became livid, but this lividity subsided after a few hours. The aneu rism shrunk to one-half its original size within a few minutes. Seven days later the femorals were found to be pulsating slightly, and the legs had regained their warmth. The amount of uri- e excreted after the operation gradually reached the usual pre-operative amount. Forty eight days after the operation the patient died suddenly from hrnorrhage due to ulceration of the aorta at the seat of ligation. Personal opinion that this re sult will almost certainly follow in any case of ligation of the aorta in which death does not result from other causes, and a removable clamp (devised by the author) to be placed upon the aorta through an abdominal incision and capa ble of being loosened, tightened, or re moved, at will, becomes necessary. Keen
(Amer. Jour. of Med. Sciences, Sept., 1900).
The case of an abdominal aortic aneu rism in a woman noted. There was a systolic "bruit" over the area, but the heart was normal. Gelatin was given per mouth. Twenty grammes dissolved in normal saline were given daily. The recumbent position was maintained and ice-bags continuously applied to the ab domen. Two months afterward the tumor was less resistant and smaller. The ice-bag was then used during two hours daily, and the gelatin given every other day. Four weeks later the aneu rism could only be felt as a slight thick ening. The ice applications were now suspended, and a solution of ichthyol in CHCI, and camphor spirit was rubbed over the painful places. The gelatin was continued for four weeks. and the patient allowed to gradually resume ordinary duties. Buchholz (Norsk Aiag,. f. Laege vidensk., p. 185, 1900).
Iliac Aneurism.
An aneurism may form on either the common, internal, or external iliac arter ies or one of their branches, and be, as in other regions, idiopathic or traumatic. In the latter case, however, the external iliac is almost always the portion in volved.
Symptoms.—The enlargement appears as a circumscribed swelling in the line of the vessel, presenting the characteristic expansive pulsation and bruit along its course. If the genito-crural is pressed upon, pain may be a prominent feature of the case. Owing to the ease with which the surrounding organs may grad ually be displaced. however, the aneu rism attains a large size before it is dis covered. (Edema and gangrene some times result from the pressure induced on venous trunks. If left to itself an iliac aneurism usually ruptures.
Differential Diagnosis.—Enlarged glands near Poupart's ligament may sim ulate an iliac aneurism. The glands are not pulsatile and cannot be emptied by pressure, while no bruit can be detected. Tumors and abscesses may be differen tiated in the same way.
Treatment of the common iliac artery is best treated by compression above the aneurism, as little as possible over the sac. A mortality of almost 75 per cent. is found as a result of ligation of the common iliac for aneurism.