THE following case of retroperitoneal cyst is, I think, of sufficient interest t o warrant its report.
A boy, age 12, was admitted to the Royal City of Dublin Hospital on Saturday evening, June 2, 1923, with symptoms of acute abdominal affection. He stated that on the previous Thursday he felt a stinging pain radiating from the left side of the abdomen ; he took little notice of this, and went out, but when he got back he was so bad that hc had to go t o bed. He vomited once only. He got gradually worse, and on Saturday he was seen by a doctor, who sent him into hospital. On admission he was flushed, with furred tongue, pulse 100, temperature 99.#O, and respirations 2s. The patient was doubled up with pain, his respirations were shallow, and there was rigidity over the right side of the abdomen, and teiiderness in the right iliac fossa and towards the umbilicus.
The abdomen was opened through thc outer border of the right rectus. There was a small amount of clear fluid in the right iliac fossa, and a small oval swelling was seen outside the junction of the czcum and the ascending colon, with a patch of lymph on its summit. The appendix was normal. The swelling, which evidently contained fluid, was seen to spread towards the middle line behind the ascending colon, mliich was more or less flattened. After the general peritoneal cavity had been packed off, the swelling was opened outside the ascending colon, when several ounces of fluid escaped, a t first purulent, then serous, with masses of fibrinous exudation. On cxploring the interior of the cavity it was found to stretch as far as the middle line, downwards to the ileoczcal angle, and upwards to the region of the duodenum. Some B.I.P.P. was put into the cyst cavity, and a split rubber tube with R B.I.P.P. gauze wick. The opening in the cyst mas closed with a purse-string suture around the tube, and fixed to the anterior parietal peritoneum. The edges of the u~ouncl were then closed tightly around the tube. The discharge, which at first was considerable and purulent, soon diminished and became serous ; in three weeks it had ceased and the wound clo\ed, the patient leaving hospital on the twenty-fifth day after operation. Some of tht. exudate ~ ~~ ~~ ~ * Paper read bcforr the Surgical Section of the Royal Academy of Medicine in Ireland, Dec. 7, 1033.