[Reprinted from The Medical News, April 13, 1895.) 
SUCCESSFUL REMOVAL OF A LARGE TUMOR 
OF THE MESENTERY, WITH RESECTION 
OF 43 INCHES OF INTESTINE; END- 
TO-END ANASTOMOSIS WITH 
MURPHY BUTTON. 
By F. CAUTHORN, A.M., M.D., 
OF OREGON ; 
PROFESSOR OF SURGERY, MEDICAL DEPARTMENT WILLAMETTE UNIVERSITY ; 
VISITING SURGEON TO PORTLAND HOSPITAL ; 
SURGEON N. P. R. R. CO. 
M. P. T., aged forty-nine years, a farmer, was broughtto 
Portland Hospital, January 16, 1895, for operation, by Dr. 
G. W. Maston, of Albany, with whom I saw him in con- 
sultation. Dr. Maston had noticed for about three years 
the presence of a hard tumor in the abdomen, which 
had grown more rapidly in the last three months, until 
it was now approximately the size of a double fist. A 
diagnosis of solid tumor, probably malignant, of the 
mesentery was made, and an exploratory operation was 
agreed upon and was performed the next day, January 
17, 1895. Dr. Maston made the opening into the abdo- 
men and exposed the tumor, which could be lifted out 
of the abdominal wound. A careful examination revealed 
the intimate attachment to the tumor of a large extent 
of intestine. After consultation as to the feasibility of 
removal I proposed to Dr. Maston the resection of 
the intestine involved in the tumor. To this the doc- 
tor gave his consent and asked me to execute the oper- 
ation, which was done with his assistance. The tu- 
mor was located in the mesentery and had encroached 
upon the intestine until the mesentery upon this side of 2 
the tumor had been completely obliterated. Fortunately 
there was free mesentery between the tumor and the 
posterior mesenteric attachment. The tumor was ap- 
proximately seven inches in diameter in its greatest 
breadth and four to five inches in its least, and of almost 
cartilaginous hardness. The amount of mesentery in- 
volved at its base was between six and seven inches. 
The details of the operation are perhaps non essential, 
except in one or two particulars, and I will confine my 
report to these. The two points of most importance were 
to cut the gut where its blood-supply would not be inter- 
rupted by the extensive section of the mesentery, and to 
handle this extent of mesentery without excessive hem- 
orrhage. By lifting the tumor up, and thus putting the 
mesentery on the stretch against the light background 
of a window opposite, it was rendered semi-translucent, 
and the bloodvessels (principally the veins, I believe) 
could be quite readily discerned in their course through 
it to and from the gut. A point was selected on each 
side of the tumor which this blood-supply seemed to 
reach, passing clear of the tumor, and was marked by 
passing a heavy silk ligature around the gut at this 
point. These ligatures were tied loosely, merely to close 
the caliber of the gut and to facilitate handling the ends. 
The gut was then cut with scissors at these points and 
the mesentery torn downward until clear of the base of 
the tumor. I can recommend this maneuver, because the 
tear will follow the general radiations of the mesentery, 
and starting right I can hardly conceive that any vessel 
of any importance can be torn across. With the mes- 
entery still upon the stretch, it was cut for perhaps three- 
fourths of its extent across the base by successive half- 
inch snips of the scissors, without any hemorrhage worth 
mentioning. The balance of it was then ligated en 
masse with two heavy silk ligatures. The bleeding was 
thus effectually prevented and did not exceed one-and- 
one-half ounces in the whole operation. The mesentery 3 
was stitched together with a continuous catgut suture 
after the usual method, and the intestine united end-to- 
end with the No. 4 Murphy button. The large-sized button 
was used because the caliber of the intestine was above the 
average and accommodated the button without difficulty. 
Thanks to Dr. Murphy, the approximation of cut intes- 
tine is the simplest part of intestinal surgery. It is sim- 
ply a new version of the old story of Columbus and the 
refractory egg. The toilet of the peritoneum was made 
and the abdominal wound closed by Dr. Maston. 
The case was reported to the Portland Medical Society 
on January 23d, and the resected intestine measured in 
the presence of the Society full 43 inches. 
The accompanying illustration shows the tumor with 
the intestine inflated. I confess to some astonishment 4 
when first measuring the gut, as the unfolding of the re- 
duplications ran rapidly into feet. I had supposed I was 
removing about eighteen inches. The intestine resected 
was undoubtedly from the ileum, but just what portion 
I am unable to say. 
The time occupied in the operation was about one hour. 
The patient was put to bed with a pulse of 84 and no evi- 
dence of shock. There was a reactionary temperature of 
1020, but this fell to normal at the end of forty-eight hours, 
and subsequent progress to recovery was practically with- 
out incident worthy of mention. Flatus began to pass 
about twelve hours after the operation. The bowels re- 
sponded to enemata given once daily until about the six- 
teenth day, when they began to move of their own accord. 
The man was allowed only water for the first two days, 
and then liquid food, broths, milk, etc., until about the 
twentieth day, after which time suitable solid food was 
allowed until he has now, for some time, been taking 
regular diet. He has, in great part, recovered his strength 
and weight. This is now the forty-seventh day, and we 
have not yet seen the button. The nurses are instructed 
to watch carefully for it; but considering the early pas- 
sage of formed stools, I think it may have been over- 
looked. However, when we bear in mind one of the 
cases reported by Dr. Murphy in The Medical News of 
February 9, 1895, in which the button was passed after 
two months, and also with the entire absence of any 
symptoms indicative of the presence of a button in 
our patient, we have every reason to hope that no com- 
plications will arise at this late date. 
In the interest of statistics in the use of the Murphy 
button I shall, however, report any developments that 
may arise in the future. 
The case is interesting for the following reasons : 
i. The extensive amount of intestine removed, forty- 
Summary. 5 
three inches, without apparent discomfort, gives us cour- 
age in this line of work, having been excelled in this 
country, so far as I know, only by the case of Dr. J. W. 
Elliot, of Boston. 
2. The method described, whereby the points of sec- 
tion of the gut were definitely located, I think of value. 
3. The ease and safety with which the mesentery may 
be torn in the course of the bloodvessels commend this 
method as superior to cutting. 
4. It adds one more successful case to the already 
large and fast-growing record of the Murphy button. 
The specimen was submitted to Dr. Everett Mingus, 
Professor of Surgical Pathology of the Medical Depart- 
ment of the Willamette University, who has returned 
the following report : 
Portland, Ore., February, 1895. 
Upon examining specimen given by Dr. F. Cauthorn 
a-nd taken from a tumor from the mesentery, I note the 
following conditions : 
The specimen is firm on pressure and has a gritty 
resistance to the knife ; that part of the specimen which 
corresponds to the periphery of the tumor has cyst-cav- 
ities. 
Microscopically it is characterized by almost perfect 
uniformity in cellular construction. There are a few 
delicate bands of connective tissue passing in various 
directions through the specimen, but the fibrous tissue is 
an entirely subordinate element in comparison with the 
great mass of embryonal connective cells that make up 
the tumor. The embryonal connective-tissue cells are 
of the large spindle-cell variety, and toward the center of 
the tumor show degeneration; toward the periphery of 
the tumor there is considerable fatty tissue. The blood- 
vessels have no distinct walls. 
From the above appearances the nature of the speci- 
men is that of large spindle-cell sarcoma. 
Respectfully, E. Mingus.