Reprint from the “Revista Medical Santiago. 
Laparatomy consecutive to an operation for 
Suppurative Appendicitis. 
Hector Garcia, aet. 12. was taken ill on the 2G‘" of May and Dr. F. Echeverria 
who was called in, diagnosed appendicitis. After treatment for several days, the 
case not doing well, Doctors J. Trumbull and N. Martinez were called in con- 
sultation. On the 4th of June I was invited to see the child, with a view to 
operating upon him. He had then fever (39.5), a quick pulse, general abdominal 
pain, more intense however in the iliac fossa. There was swelling in the right 
iliac fossa with marked dulness, and in the left, slight dulness on percussion. The 
patient vomited everything he took, and there was no action of the bowels. Urine 
of natural colour was freely passed. It was decided to operate on the following 
day. On the morning of the 5U the boy was placed on a table, chloroform 
administered, and the abdomen thoroughly washed with soap and warm water. 
An incision about G centimetres in length was made over the most prominent part 
of the dull region. A considerable quantity of pus escaped, and after irrigating 
the cavity with a warm solution of lysol (1—300), a coil of intestine was found 
lying immediately under the median side of the incision, which, had an explora- 
tory puncture been made, would surely have been pierced. The finger introduced 
into the abscess cavity could not make out the appendix. This cavity, which appeared to be circumscribed was well packed with thin strips of iodoform gauze 
and the wound itself covered with the same and absorbent cotton. For three 
days after the operation there was more or less vomiting, which was best allayed 
by the drinking of hot water. Until the 12th the temperature ranged about *’>7.5, 
after which it became normal. The pulse during the same time fell from 120 to 
104, and after the 15l!l it did not rise above 80. Small quantities of champagne 
were given, and for three days after the operation, injections of peptonized food 
were administered. The packing of iodoform gauze was removed twenty-four 
hours after the operation, and the internal wound dressed with the gauze and 
cotton and lysol irrigations made twice a day. Four days after the operation, the 
bowels were for the first time moved. Everything now went on well for several 
days, with the exception of a certain sluggishness of the lowels, which required 
the use of enemata. I must however add, that for some days after the operation 
there was great pain in the left iliac fossa with a certain amount of dulness. But 
as there was no fever and no oedema of the skin could be detected, it was de- 
termined not to interfere, and most happily, as the pain soon passed off. As it 
was now evident that the bottom of the wound was closed, great hopes were at 
last indulged in, that all danger was at an end. On the 2Gth of June, however, the 
patient began to feel pain in his abdomen, which soon became intolerable. It was 
accompanied by vomiting of dark green colour, with complete and insuperable 
inaction of the bowels. The kidneys, however, continued to act freely. Withal, 
there was no rise in temperature, but the pulse went down to 54, becoming 
irregular and intermittent. The patient’s features assumed a pinched look, and 
it was felt by all, that if relief were not quickly obtained, death would soon ensue. 
As there had been no rise in temperature and no rigors, it was not thought likely 
that these new features of the case could be due to retained pus, but that they 
were more probably owing to adhesions or peritoneal bands, obstructing the bowels. 
At 5 P. M. on the 2n<1 of July the case looked so desperate, that I' decided upon 
operating as soon as all necessary arrangements could be made. At 8 P. M. the 
patient was chloroformed, and by the light of a gas chandelier and a couple of 
candles, I proceeded to open up the wound of the first operation. There was no 
escape of pus. On exploring I found the coil of intestine which I have already 
spoken of, adherent to the parietal peritoneum. This was gently and at the same 
time easily detached. Further, two thin bands to the left of the median line were 
found, binding down intestinal coils but not being within easy reach the incision was freshened up, and brought together with five silk sutures, and a median laparotomy 
proceeded with at once. This was 10 centimetres in length, the umbilicus being 
exactly at its middle point. A dense band was found G centimetres in width, 
firmly holding down, but not adherent to the intestines beneath. This divideJ 
with scissors, the intestines, considerably inflated, were so to say, shot out, but at 
once covered with cloths wrung out in warm water. The other two small bands 
were now tied with catgut and cut, and the intestines after some difficulty replaced 
and kept in place by the introduction of a large flat new sponge, which had been 
cleansed in the house and allowed to soak for a couple of hours in a lysol solution 
(1—100). The incision was closed with nine silk sutures and covered with gauze 
and cotton. On the following morning the temperature was 37.8 and pulse 120. 
This lime there was very little vomiting, but the pain was so great, that for two 
nights follow ing it was found necessary to inject Morphia subcutaneously. On the 
4th day, the bowrels were naturally and freely moved. The pulse went down to 
75—80 and Ihe temperature became normal. On the 7th day the sutures were all 
removed leaving slight suppuration in the tracks of two of them, which how’ever 
soon disappeared. With the exception of two attacks of colic which required castor 
oil, convalescense wTas uninterrupted, and at this date the patient is in the best of 
health. 
Dr. OLOF PAGE. 
Valparaiso, September 8th, 1894.