When parotitis complicates post-operative convalescence, it is almost
entirely confined to septic cases: it may occur within two days of the
operation or as late as the thirtieth day. It is more common between the
sixth and tenth days, and its advent is accompanied by much disturbance.
The parotid swells and becomes painful and tender; the skin over it is
red and often brawny. These signs are accompanied by fever, malaise, and
depression of spirits. In mild cases they subside in a few days, but in
severe cases rigors occur, with high fever and suppuration.
The mild cases are best treated with warm fomentations, frequently
changed. If suppuration occurs, the pus will need to be evacuated by a
scalpel, but incisions in a suppurating parotid gland should be carried
out with careful regard to the branches of the facial nerve (pes
anserinus), and the large vessels intimately associated with it.
The surgeon need not be in a great hurry to use the scalpel in these
cases, for it seems occasionally as if the skin would slough, and yet
when it is incised no pus escapes. This septic parotitis is deceptive in
the red and brawny appearance of the skin covering the swollen gland,
and the misleading sense of fluctuation. In many instances the
inflammatory products escape by way of the parotid duct.
Septic parotitis is an unpleasant and painful complication of an
abdominal operation, but it is rarely dangerous and has only had a fatal
termination in very exceptional cases.
=Thrombosis.= After operations on the pelvic organs, thrombosis
occasionally occurs in the iliac, femoral, and saphena veins,
accompanied by fever, pain, especially in the course of the long
saphenous vein, and œdema of the limb. It is noticed most frequently
about the twelfth day after operation.
In some patients the thrombosis is confined to the superficial veins of
the calf and thigh, but when the femoral and internal iliac veins and
the associated lymphatics are involved, the œdema is of a solid kind.
Apart from the danger which ensues from the detachment of a fragment of
clot and its arrest in the pulmonary artery, this complication is often
very serious for the patient, for it entails a long confinement to bed,
a tedious convalescence, and the œdema of the limb will sometimes
persist for many weeks or months, in spite of topical applications,
careful bandaging, or judicious massage.
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