LIGATURE OF THE GLUTEAL ARTERY 
FOR 
TRAUMATIC ANEURISM. 
BY GEO. W. CAMPBELL, A.M., M.D., L.R.C.S.E., &c. 
Professor of Surgery, McGill University, Montreal, 
The patient was under the care of Dr. Fenwick, from the occurrence of the 
accident till the 29th January, and the description of the case till that period is 
from his notes. 
“ C. A., get, 14 years, small but muscular for his age,was accidentally wounded 
in the right buttock on the afternoon of Friday, 17th January, 1862. 
It appears that he had taken a small sled to a blacksmith’s shop to have some 
part of it ironed; the smith had heated a piece of iron of about the size of a 
3-inch nail, intending to bore a hole with it in a slender piece of wood; as he 
left the fire with the iron in his pincers, heated to whiteness, he accidentally 
came in contact with the boy, but as he sprung out of the way, and did not ex- 
press any sense of pain, the smith paid no attention to him but proceeded with 
his work. 
In a few moments the boy said, “ I am bleeding. 1 he smith at once 
turned to him, took down his trowsers, and in doing so blood, in a considerable 
stream, spouted out of a small hole in the buttock. He immediately placed his 
finger over the wound, but "had hardly done so before the boy fainted. Still re- 
taining his thumb in position, he carried him to his father’s office which was in 
the neighbourhood. When I saw him he was pale, exsanguine, and almost pulse- 
less; complained of dizziness, singing in the ears, and said he felt sick at the 
stomach. No pain or uneasiness was experienced in the wound, and with some 
little difficulty I induced the blacksmith to relinquish his hold. As he did so a 
drop or two of dark coloured blood welled from a small wound, in size about 
that of a pea, situated about one inch and a half behind the light tiochanter 
major. The trajet of the wound appeared to pass upwards and backwards. I 
made no examination of its depth, but applied a graduated compress and roller, 
enjoined perfect rest, and ordered cold water dressing. The following day t ere 
was slight uneasiness felt in the wound, and general tenderness all over the but- 
tock. The bandage was removed, but the compress was left, letaine in post 
tion by adhesive plaister. On the fourth day, great pain of a bursting character 
extending down the back of the thigh was complained of. On removing the 
compress, a considerable quantity of pus flowed from the wound, w ic was 
Wed by a bloody ichor. This gradually >red in character, becoming puru- 2 
Tent, and lessening in quantity. The lips of the wound presented a charred ap- 
pearance, and a small slough was separating. The following Sunday, ten days 
after the accident, he got up and was going about the house ; the limb was stiff 
and sore, and he could not walk without the help of a stick. There was very 
slight discharge, and healthy granulation had filled up from below. The next day, , 
Monday, in attempting to leave his bed, blood in considerable quantity spouted 
again from the wound. I saw him shortly afterwards, but the haemorrhage had 
been quickly arrested by a compress and ice. He was suffering much pain in 
the buttock and calf of the leg. On Wednesday, the 13th day after the acci- 
dent, while I was in the house, he called out that it was bleeding again. On 
removing the dressings, a stream of arterial blood spurted from the wound with 
considerable force; I immediately arrested it with my finger, and in doing so, 
felt the blood well up against the finger, and elevate the buttock into a sack, 
which I judged to be about the size of a hen’s egg.” 
It was at this point in the history of the case, on Wednesday, 29th January, 
twelve days after the occurrence of the injury, that Dr. Fenwick, who has kindly 
favoured me with the foregoing statement, requested me, in conjunction with Dr. 
Jones, to visit his patient. Upon examination the small punctured wound al- 
ready described, was observed, which led to a tumour three inches posterior to 
the right trochanter, about the size of a hen’s egg. The tumour was beneath the 
gluteus maximus muscle, was very painful to the touch, and a faint bruit was 
heard in it, upon the application of the stethoscope. It was evidently aneuris- 
mal, and from the course of the wound, which ran backwards and upwards for 
about three inches in the direction of the sacro-sciatic notch, it was believed to be 
traumatic aneurism, either of the trunk, or one of the large branches of the 
gluteal artery, in the immediate vicinity of the notch. 
It was agreed to try the effect of injecting the aneurismal sac with the solu- 
tion of the perchloride of iron, to endeavour to produce coagulation of its con- 
tained blood, with the hope that further operative proceedings might thereby be 
rendered unnecessary. The stilette of the syringe was introduced into the sac 
through the wound, and one drachm of the fluid injected. The tumour became 
hard immediately after the injection, and all haemorrhage ceased. The discharge, 
a couple of days afterwards, again became purulent, and the indications seemed 
to promise a successful result, when on the following Monday, five days after the 
injection, being in the immediate neighbourhood, I was requested in great haste 
to visit the patient. I found there had been a recurrence of free arterial hae- 
morrhage from the wound, a vermiform clot of about three inches in length having 
been previously expelled by the vis a tergo. The boy’s mother had arrested the 
bleeding, by placing her finger upon the orifice of the wound. He complained 
of great pain and a feeling of tension in the hip, which was evidently elevated 
and tense from the sudden distension of the sac. I covered the wound and tu- 
mour with snow, and requested his mother, should bleeding again recur, to place 
her finger as formerly upon the orifice of the wound, appointing to return with 
Dr. Fenwick and some other professional friends in a few hours thereafter, to 
take more efficient measures for the permanent arrest of the haemorrhage. 
Upon consultation, three methods of procedure were discussed : 1st. To cut 3 
into the arieurismal tumour, to turn out the coagula, look for the mouth of the 
wounded vessel, and secure it where it entered the sae; 2nd. To endeavour, if 
possible, to avoid opening the sac, cutting down upon the trunk of the gluteal 
artery, and tying it where it emerges from the sciatic notch, and 3rd. To liga- 
ture the internal iliac. This last, although the proper operation for spontaneous 
aneurism of the gluteal, was rejected as unsuited to traumatic aneurism, and the 
2nd was selected, as likely to be less bloody than direct incision, and unattended 
with any of the dangers of peritoneal inflammation, and less hazardous in its 
consequences than deligation of the iliac ; besides it was in close proximity to the 
injured part of the artery, and on that account a better operation for traumatic 
aneurism. I was assisted by Drs. Sutherland, Scott, Fenwick, and R. P. 
Howard; the first named gentleman compressed the abdominal aorta against the 
spine, by means of a small book, and the others were prepared to assist in the 
steps of the operation, and in arresting haemorrhage, should the incisions, to 
reach the trunk of the artery, open up the sac. The patient was put under 
chloroform, turned upon his face, and the operation commenced by making an 
incision about 6 inches long, from half an inch below the posterior spine to- 
wards the trochanter, through the integuments and subjacent cellular membrane, 
down to the gluteus muscle, the fasciculi of the muscle were then separated to 
the same extent, and in the same direction as the external wound, by the handle 
of the scalpel, the sides of the wound were separated by curved retractors, and the 
deeper layer of muscles was exposed. Not half an ounce of blood was lost. 
There was no need for hurry in the further steps of the operation; the pulsation 
of the artery was felt for at the upper and anterior portion of the notch; and 
when discovered, the aneurism needle, guided by the forefinger of the left 
hand, which was held on the artery deep in the notch, was placed under it; the 
end of the ligature was with some difficulty, from the great depth of the vessel, 
seized with a pair of dissecting forceps, and the artery was felt pulsating in the 
bight of the ligature before it was tied. From three to four ounces of coagulated 
blood were then pressed out of the sac, through the wound made by the nail, 
the trajet of which ran parallel to, and about half and inch beneath, the line ot 
incision. The haemorrhage having been found to be completely arrested, the 
sides of the wound were brought together by metallic sutures and adhesive straps, 
the boy was put to bed, and water dressing applied. Free suppuration both 
from wound and sac, commenced about the third day, and the ligature came 
away on the 6th day. A considerable quantity of offensive pus continued to be 
discharged for several weeks from the sac, the wound at length healed up, and 
the boy has now recovered perfectly. 
I believe the plan of procedure selected in this case, the details of which have 
just been given, was more fortunate in its results, and certainly much less diffi- 
cult in its execution, than if the ordinary rule in traumatic aneurism had been 
adopted, to open the sac and secure the orifice of the artery where it entered it. 
The patient was so anaemic from the previous haemorrhages, and so greately re- 
duced in strength from suffering and confinement, that it was essential to 
bis very existence, that the operation should be performed with as little loss of 
blood as possible. 4 
The original operation of John Bell, and the recent one of Mr. Syme of 
Edinburgh, where the sac was opened, were most formidable and bloody on that 
account. Few surgeons after perusing the details of Mr. Syme’s case, so cour- 
ageously and skilfully conducted to a fortunate termination, would, if any other 
feasible plan could be adopted, willingly undertake such an operation. I am 
aware that it might be objected to the method adopted in this case, that possibly 
the aneurism might have been formed upon a branch of the Sciatic artery; this, 
from the direction of the wound, I considered as very improbable, and granting 
that it was so, and that the ligature of the Gluteal had failed to check the bleed 
ing, by drawing downwards the lower lip of the wound already made, the infe- 
rior margin of the pyriform muscle might have been reached, and the sciatic 
artery secured. 
Montreal, 10th April, 1862.