WILLIAM HUNTER, in 1761, clearly described arteriovenous aneurysm.l In the war of 1914-8 numerous cases were recorded.2 Sir George Makins, in his reviewY3 after the war, of the injuries of the blood-vessels, stated that aneurysmal varices, of which this case is an example, and which are due to war wounds, are usually overlooked at the early stage. The serious cardiac disturbances that may follow from the alterations in circulation are now well accepted, due largely to the work of Reid: Holman: Matas: and Pemberton and Waugh.' CASE REPORTThe following case is of special interest as it demonstrates in striking manner the pathological anatomy of the local lesion :-HISTORY.-PriVate w. B., aged 21 years, was wounded in Belgium by a machine-gun bullet on May 22, 1940. The bullet passed through his left thigh, leaving small entrane and exit wounds. For twenty-four hours he lay on the field and readily controlled some '' moderate " haemorrhage by himself, applying his field dressings. Four days later, he was anaesthetized and, as far as can be ascertained, vaseline packs were inserted into both wounds for drainage. On May 29 he was evacuated from Dunkirk and admitted to a hospital in Lancashire. He was kept in bed until the end of June when the wounds had soundly healed, apparently with very minor sepsis. As soon as he commenced to walk, the left leg began to swell and he was conscious of a peculiar " purring " feeling in the thigh.ON ADMIssIoN.-On September 6 he was admitted into this hospital and the following features were noted : There was a scar on the outer side of the left thigh and another on the inner side over the apex of Scarpa's triangle. No tumour was visible, but a swelling could be felt over the line of the femoral vessels in Hunter's canal and there was a marked palpable thrill. A very loud continuous bruit could be heard over it, the bruit being intensified with systole and conducted downwards to below the knee and upwards to Poupart's ligament. The left leg was obviously larger than the right and the circumference of the calf was I+ in. greater.Compression of the femoral artery against the pubic ramus caused the thrill and bruit to disappear. There were no heart murmurs and a radiological examination confirmed the clinical finding that it was not enlarged. The pulserate was 76-80 at rest, and his blood-pressure 130/8o mm. OPERATION (Mr. W. H. Ogilvie).-On September 17 (four months after the injury) under evipan and gas and oxygen anaesthesia a long incision was made in the line of the artery. No tourniquet was used. After incising the roof of Hunter's canal the aneurysmal dilatation could be made out. The vein and artery were then defined for about 2 in. above and below the tumour. Quadruple ligature, using No. 4 silk, was then performed, and the whole mass carefully dissected out and removed. The blood-pressure, which was 130/80 before ligature, changed to 11o/g0 immediately after tying the artery.PRoGRESS.-The leg remained warm after the operation, and the dorsalis pedis artery was felt pulsating on S...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.