LUNG, Abscess of.
The management of the case should be that suitable for pulmonary phthisis or lung gangrene, as improved feeding, open-air life, &c., and the administration of volatile antiseptics by the stomach and by inhalation in order to diminish the tendency towards secondary septic infection from germs in the respired air.
Surgical procedures are available in a considerable percentage of cases, and where the abscess is situated near to the lung surface a satisfactory result may be achieved by pncumonutomy. After localising the abscess cavity by X rays, bronchoscopy and by the insertion of an exploring needle a free incision is made under local anaesthesia; portions of the overlying ribs having been excised, the lung is fully exposed. When complete adhesions shutting off the pleural cavity are found present it is only necessary to incise the lung substance with a scalpel or to open the abscess cavity with the thermo-cautery and after evacuation of the pus to insert a large drainage-tube without any attempt at irrigation, as in empyema. But in the absence of adhesions the pulmonary and parietal pleurae must be carefully stitched together by a ring of sutures introduced through the lung tissue before opening the abscess.
Somd surgeons operate in the air-tight chamber of Sauerbruch under a negative pressure of io milligrammes Mercury with the head of the patient projecting through an aperture in the wall of the cabinet, whilst others raise the atmospheric pressure in the lung by pumping in air through a helmet apparatus applied to the patient's face in order to prevent collapse of the lung by air entering the pleural sac. Neither of these precautions are necessary if the suturing of the two pleural layers be accomplished with thoroughness. It is advisable, however, to perform the operation in two stages; the wound after suturing the parietal pleura to the lung having been carefully plugged with gauze, the abscess cavity may be opened after 48 hours with the aspirator, by inserting a trochar and canula, incising with the knife or entering with the thermo cautery and leaving in a drainage-tube.
Some surgeons have achieved occasional success by making an artificial pneumothorax. Pneumonotomy is not admissible for the treatment of tuberculous cavities, but is clearly indicted in those cases of pulmonary abscess following pneumonia and hepatic suppuration.