A REVIEW of the literature to date regarding the use of thorotrast reveals no report of its use or attempted use in the diagnosis of trauma of the liver and spleen. It has been used in the diagnosis of pathologic conditions affecting these organs, but not in traumatic surgery. All the cases recorded have been observed for some time and in many instances normal structures were found. In some cases the drug was administered to normal patients and in other cases animal experimentation served the observers' purpose. Herein, therefore, is presented what is believed to be the first case on record in the use of thorotrast in the diagnosis of traumatism of the liver and spleen. Case History A colored male was admitted to the Alexandria Hospital, May 1, 1932, on the service of Dr. M. D. Delaney, Sr., as the result of an automobile accident. He was unconscious and from the physical signs and the testimony of his companions was in the state of acute alcoholism. Differentiation between surgical shock and alcoholic intoxication was impossible at this time. Expectant and supportive treatment was ordered until the next morning, when a more accurate diagnosis could be made. As the result of a thorough physical examination a diagnosis of intra-abdominal hemorrhage was made and the patient was operated upon twelve hours after admission, by Dr. Delaney. At operation, a rupture of the jejunum was found, together with a stellate rupture of the quadrate lobe of the liver immediately to the right of the midline, and a rupture of the lower pole of the spleen. The intestine was sutured and the ruptures of the liver and spleen were packed. Closure with drainage completed the operation. During the operation the pulse varied from 126 to 160 and the respiration from 26 to 38. Saline solution, 1,000 c.c., and adrenalin m x v. were administered intravenously during the operation. The patient was returned to the ward in fair condition. A study of the accompanying chart (Fig. 1) shows not only the range of temperature, pulse, and respiration, but also the intravenous therapy including one transfusion. The first injection of thorotrast, 14 c.c., was given, without saline or glucose solution, 48 hours after operation. The second dose of the drug (24 c.c.) was given with 50 c.c. of normal saline solution, 96 hours after operation. A further study of the chart shows that there were no untoward reactions as a result of the administration of the drug. The packing in the liver and the spleen was removed in 48 hours and thereafter the patient drained fresh bile and a seropurulent exudate continually. Although strenuous supportive treatment was given, he was unable to overcome the peritonitis and died six days after operation. Roentgenologic Report A stereoscopic study shows a marked dilation, with gas, of the entire stomach such that its complete outline is visualized and also the organs placed posteriorly to it.
No takes yet. Share an insight, caveat, or question.
Burke et al. (1933) studied this question.