Post-operative thrombosis was formerly fairly common after hysterectomy
for fibroids and in the later stages of malignant disease of the uterus.
Its frequency after operations for fibroids was attributed to the
profound anæmia in patients who had severe and exhausting metrorrhagia.
I am convinced that it is due to sepsis. In several instances I have
caused the clot found in thrombosed veins to be examined
bacteriologically, and pathogenic microscopic organisms have been
isolated. I am also satisfied that in some cases of thrombosis of the
veins of the thigh, especially those limited to the saphenous veins, the
clotting spreads from the superficial veins of the hypogastrium which
are infected from the abdominal incision.
=Pulmonary embolism.= In perusing the clinical histories of a series of
cases of ovariotomy, hysterectomy, myomectomy, and, indeed, after almost
any surgical operation, here and there a record may be read to this
effect: ‘The patient appeared to be doing well after the operation, when
she sat up, laughed and chatted with the nurse, then suddenly fell back
and died in a few minutes.’
Anything more tragic than this it is difficult to conceive, and, as a
rule, after such a sad occurrence, the relatives are so distressed that
they rarely permit an examination of the body. Death in such
circumstances is usually attributed to embolism of the pulmonary artery.
In some instances this is an assumption, but there are many in which an
embolus has been demonstrated, and a few in which the source has been
detected.
Post-operative embolism of the pulmonary artery is an important matter
for surgeons interested in the operative treatment of uterine fibroids,
for it follows such operations more frequently than any other. In order
to afford some notion of the relative liability of patients to this
accident after subtotal and total hysterectomy for fibroids, I have
gathered the following statistics, which are interesting as showing an
extraordinary variation in the practice of different operators:--
Baldy ascertained that among 366 operations for fibroids in the Gynecean
Hospital, Philadelphia, there were thirteen sudden deaths attributed to
pulmonary embolism.
In the Middlesex Hospital between the years 1896 and 1906 (both years
inclusive) there were 212 abdominal hysterectomies performed for
fibroids. Three of the patients died from pulmonary embolism. Spencer,
in eighty-five total hysterectomies, had two deaths from pulmonary
embolism. R. Lyle, in eight cases of subtotal hysterectomy, had one
sudden death.
Mallet collected the records of 1,800 cœliotomies: there were six deaths
attributed to embolism, and of these, three followed operations for
uterine fibroids. Chas. P. Noble, in forty-two vaginal myomectomies,
lost two patients, one from septic endocarditis, the other from
embolism; in the latter case the fibroid was gangrenous.
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