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113
Clinical examination.—Patient a lemon-yellow colour. Mucous membranes blanched.
Body flabby. Systolic murmur at apex. Nothing abnormal found in the abdomen or central
nervous system. A trace of albumen in the urine.
Blood count serum to corpuscles 5:1, serum yellow. H/B. 28 per cent. R.B.C. 1,410,000
C.I=1. W.B.C. 6,400. Lymphocytes 42 per cent. Poikilocytosis and anisocytosis.
Polychromasia. Stippling. No nucleated R.B.C. seen.
Temperature remittent between 100•2° and 99•2°.
Patient gradually went downhill in spite of all treatment and died in March, 1922.
Post-mortem (J. A. B. H., Westminster hospital).—Very pale. Conjunctivae yellow. Two
old scars almost invisible, one 1 inch in right iliac fossa, the other 4 inches in mid-hypogastric
region. Plenty of subcutaneous fat in the body.
Heart flabby and showed an extreme degree of tabby cat striation.
Lungs.—Engorged. Nil else.
Liver.—Large, fatty and gave a well marked iron reaction.
Spleen.—Pale and large.
Hæmolymph glands along the aorta prominent. Bone marrow of sternum and femur red
and soft.
Appendix missing and both ovaries. The lower coils of the ileum, ileo-cæeal valve and
caecum were hopelessly matted together and were spread over the contents of the right half of
the pelvis. Inside the lower coil of the ileum was an ordinary pair of short Spencer-Wells artery
forceps which at the upper toothed clip were thickly encrusted with a stercolith, but elsewhere
were merely discoloured and rusty. The lower part of these forceps had pouched the bowel, i.e.,
ileum, down into the right half of the pelvis, and the tip of the forceps and the terminal ¾ inch
were embedded within the bowel in a very dense mass of fibrous tissue which was so hard as to
suggest malignant disease, but a subsequent section proved it to be entirely inflammatory fibrous
tissue. These forceps must have originally been left behind at the ovariotomy operation 17
years before, and had gradually worried their way, as such foreign bodies appear to do, into the
lumen of the gut.
From the clinical notes it is quite obvious that the patient had never suffered the slightest
inconvenience (unless constipation is to be regarded as such) or pain from the presence of this
comparatively large foreign body, and she died from pernicious anaemia which cannot really be
attributed to this foreign body.
These instruments have therefore been in situ in these two patients for thirteen
and seventeen years, respectively.
Comment.
In the first case it seems probable that an abscess formed round the forceps at
the time of her second admission to hospital three months after her operation, and
this ruptured into the adjacent bowel leaving the handles of the forceps lying in the
lumen of the bowel.
In the second case the forceps presumably eroded their way into the bowel
without causing any acute attack of inflammation.
It is remarkable that the presence of these large metallic foreign bodies can
remain in the lumen of the bowel for so long without causing irritative or obstructive
symptoms.