HEMATOCELE.
The treatment of a haemorrhage into the cavity of the tunica vaginalis testis or cord consists in rest in bed, with the patient lying upon his back and a small board placed across the upper part of the thighs, so that the swollen organ may rest upon this as on a shelf. Iced lotions or a small ice-cap may be applied to the scrotum in recent cases in order to prevent further extravasation. A cradle is necessary to keep off the weight of the bedclothes, and the bowels should be moved by a smart Saline purgative.
Hydro-hcemalocele.—Where extravasation of blood occurs into a previ ously existing hvdroccle the blood may remain fluid, and a simple tap ping operation may be tried, a moderately sized trochar and canula being employed, but should the fluid accumulate again a repetition of the tapping will most likely prove a failure for the cure of the original hydrocele. The tumour of a haunatocele is tense or solid, and if treated on purely expectant lines, the blood is seldom absorbed; suppuration may result, or the walls of the sac may become thickened or even calcified.
The best routine treatment is to open freely the tunica as in the modern operation for the radical cure of hydrocele. The clot should be turned out, the sac with the testis withdrawn from the scrotum, and the sac being turned inside out, the edges of the incision in the walls of the tunica yaginalis are sutured behind the epididymis and the testicle returned to the scrotum, drainage being provided.
When the operation has been delayed, it will usually he necessary to dissect out the thickened wall, and it may even be necessary to remove the atrophied testicle, or the entire mass including the testicle may be completely excised.
If suppuration of the contents has occurred when first seen by the surgeon, the sac should be freely incised, swabbed out with Perchloride of Mercury Solution, and free drainage established. When a luematocele supervenes upon malignant disease of the testicle, castration should be effected without delay, and the cord must be also removed high up. llannatocelcs of the cord and of the epididymis occur when blood is extravasated into encysted hydroceles in connection with these organs.
The treatment in the first instance should consist in tapping, and if the fluid returns the radical operation of the removal or excision of the cyst wall should be carried out.
PELvic ILEMATOCELE.—This condition is almost invariably due to tubal pregnancy, and the treatment consists in immediate Operation as described under Extra-uterine Pregnancy on p. 288. The following remarks apply to the treatment of those rare cases formerly regarded as extra-peritoneal luematoceles, which are now known to he examples of themalonia of the broad ligament and which can he safely treated by the expectant method.
The patient should be rapidly undressed and placed on her back upon a hair mattress, with the pelvis slightly raised by a hard counterpane folded neatly and placed under the buttocks. Collapse may be met with stimulants such as Ether, Alcohol, or Sal Volatile. Opium is the only reliable hz'mostatic and restorative in such cases, and in the presence of great pain it may he given fearlessly. Small doses are useless; 45 minims of laudanuin by the mouth or anus, or 1 grain of Morphia by hypodermic injection, should be administered as soon as possible, and the effect kept up by smaller doses repeated every hour according to the urgency or severity of the symptoms. In the intervals between the doses of opium, Brandy and Ice may be freely given; afterwards Brandy or Whiskey in small quantity, diluted with iced milk, will con stitute the best feeding during the early clays following the seizure. As soon as possible alcohol should be stopped altogether. Local treatment should consist of cold compresses or crushed ice, folded in gutta-percha tissue or oiled silk, and laid over the lower parts of the abdomen. The vagina may be packed with ice in desperate cases. At this stage some recommend brisk purging with Calomel, Croton Oil. or strong Salines. The writer has never had the courage to try these heroic remedies. Nor has he ventured to recommend tight abdominal bandaging.