Account of an Extraordinary Steatomatous Tumour, in the Abdomen of a Woman, by P. Hanly, M. D. Communicated by Charles Morton, M. D. Sec. R. S.

XVI. Account of an extraordinary Steatomatous Tumour, in the Abdomen of a Woman, by P. Hanly, M.D. Communicated by Charles Morton, M.D. Sec. R.S. Received November 8, 1770. RS. Reily, aged thirty six years, pale, tall, fleshy, and formerly of a healthy constitution, was brought to bed of a strong, lively daughter, on the twenty third day of May, 1770, in the parish of St. Anne, Dublin. In the fifth month of her pregnancy, she felt an uncommon lump in her stomach (as she expressed it), about the size of a hen-egg, which did not then give her much pain or uneasiness, and she was in hopes that her delivery would carry it off: she had towards the end of her pregnancy frequent reachings, sometimes puked, and became emaciated; three days after she was brought to bed, she found the lump and reachings had encreased; she became very uneasy, and sent for me. Upon examining her abdomen, I felt a considerable tumour contiguous to her stomach, which afterwards had greatly encreased, and was extended obliquely to her right side, as low as her navel; it lay immediately under the peritoneum and abdominal muscles, and in the progress of its encrease, I could plainly plainly feel one large, and other smaller protuberances of a firm substance, in some measure resembling the head and superior extremities of a fetus. It could be easily moved from side to side, without giving her any pain; but it resisted, and made her uneasy, when I attempted to move it downwards: her abdomen appeared plump and full, as if she had not been brought to bed; but the hypochondres were more prominent and distended, than the region below her navel. I ordered for her the simple bitter infusion with absorbent powders, and delayed giving deobstruent medicines, till she had recovered her strength after lying-in. I also desired her not to suckle her infant; but, as her husband was poor, she did not comply, by which means she quickly became greatly exhausted and emaciated. In a fortnight after her delivery, she got up daily, walked about her room, sometimes went abroad, and continued to suckle her child; but the reachings returned at intervals, the tumour increased in size, its protuberances became larger and more distinct, she was often restless, and in pain at night on lying in bed, had a hectic fever, and daily became weaker and more emaciated, with a sharp pinched-up nose, hippocratic countenance, small, quick, weak, thread-like pulse, loss of appetite, and night sweats. In five weeks after her delivery, the tumour had greatly increased in all its dimensions; and its protuberances, which to the feel seemed to resemble the head, trunk, and extremities of an extra-uterine fetus, became more palpable and distinct, as the abdominal muscles from their distension became thinner. I brought ten physicians, surgeons, and accoucheurs coucheurs to visit her; and we were all so much deceived as to be of opinion, that the tumour was an extra-uterine foetus: however, we were deterred from attempting the Caesarean operation, from a conviction that she was too weak, hectic, and reduced, to encourage any hopes of her recovery, in case it had been performed; and therefore we determined to leave the event to nature, especially as we could perceive no motion of any particular parts of the tumour, though it had greatly increased, and as it was possible that it might be some other tumour. She continued gradually declining; the tumour and symptoms increasing, during May and June; and the twenty-third day of July following, I perceived a small fluctuation of water in her abdomen, and gave her an intimation thereof, which determined her to procure another nurse for her infant; but the ascites daily increased, and in nine or ten days after, her legs and feet became oedematous, her night-sweats still continued, though her dropsy augmented, and she languished under the acute pains, more frequent reachings, hectic fever, loss of strength, want of appetite, and restless nights, except when she took an opiate, which often proved a great relief and refreshment to her. Her posture in bed now was half sitting, half lying, which was the only position she could bear without great pain and shortness of breathing. About seven days before her death, she was seized with a smart lax, which, in a few days, carried off part of the swelling in her left leg; she became somewhat lighter, and less distressed in her breathing, which made her vainly hope, that her disorder might be be carried off in that manner; but the tumour, weakness, and other symptoms increased, till the second day of September instant when she expired. After her death, on opening her abdomen, in presence of seven gentlemen of the faculty, we found about a gallon of water, and a large steatomatous tumour just under the peritoneum, near three inches in thickness, seven inches in length from her stomach to the obtuse angle of her ribs, and in some places near five inches in breadth from her sternum to the vertebrae of her back, full of prominences of different sizes. It was of a hard consistence, like tallow in its anterior part, but softer posteriorly, and divided by thin membranes into numerous cells, which were distended with hard and softer fat; it weighed seven pounds, was of an irregular figure, adhered to, and compressed, the anterior part of her stomach, and was so firmly united to the inferior surface of the liver, that it could not be separated from it without force. It pressed and concealed the colon, and extended from the stomach by her liver to the right ovarium, and vertebrae of her back: the small guts were greatly squeezed, and mostly forced towards the left side; and the anterior lobe of her liver was so compressed between the diaphragm and tumour, that it appeared flattened, smaller than usual, and in a withered, decaying state. There was nothing præternatural in the matrix, or any of the other bowels; but they were greatly compressed, and the tumour, from its membranes and contained fat, seemed to be a production and distension of that part of the omentum, which adheres to the stomach, although it reached and adhered hered to the right ovarium, liver, aorta, and colon, as well as to the stomach. The operator was for some time in search of the colon, before he found it, adhering to, and almost forming a part of, the posterior edge of the tumour. Dublin, Sept. 6, 1770. P. Hanly, M.D.