XII, B, 3 Abriol: Amoebic Abscess of the Liver 143 



interior is then examined with the finger. If trabeculae divide the cavity 

 into various compartments, they are broken down, and loose shreds of nec- 

 rotic tissue hanging from the shaggy wall are brought away. The interior 

 is wiped dry with narrow strips of gauze armed on a clamp, several of the 

 strips being allowed to remain in the cavity after it is comparatively 

 cleansed, and the free ends are brought to the surface of the abdomen to 

 act as a drain. Alongside these strips is inserted a large, firm, rubber 

 tube, 1.5 cm. in diameter, with 2 openings cut into its sides near the end 

 projecting into the abscess cavity, and the free end is anchored in the 

 abdominal incision at the point best adapted for drainage. The soiled 

 gauze strips protecting the intestines are removed after clean strips in 

 equal number have been placed underneath them, i. e., between the original 

 gauze strips and intestines, and these in turn are substituted by one strip, 

 10 cm. wide, for abdominal drainage, carried to the farthermost point 

 posteriorly underneath the liver, and so placed that when spread out its 

 edges will overlap the liver incision. If the operation was on the upper 

 anterior surface of the liver the gauze protecting the suprahepatic space 

 is removed, the space is wiped dry, and narrow gauze strips 4 cm. wide are 

 placed on each side of the liver cut and brought out of the abdominal wound. 

 We have then these gauze strips for drainage through the abdominal wall, 

 beside the rubber tube; 1 piece 10 cm. wide, and of 8 thicknesses, for the 

 abdomen; 2 narrow strips for the abscess cavity (2 narrow strips being used 

 in preference to 1 broader one on account of ease in withdrawal) ; and if 

 the abscess was on the upper anterior surface, 2 additional narrow strips 

 as guards of the suprahepatic space, 1 on either side of the liver cut. 

 The destination of each set of strips is marked by tying black or white 

 sterile silk to the free ends before the abdomen is closed. 



Dr, P. K. Gilman, of the department of surgery. University 

 of the Philippines, in his wide experience with amoebic hepatic 

 abscess has evolved a very good operation. "In this method the 

 high, right rectus incision is utilized and a thorough digital 

 examination of the liver is made. In certain cases where this 

 method fails, a narrow gauze packing such as that used in uterine 

 operations is tucked in around a circumscribed area of the liver, 

 walling off the abdominal cavity. A long aspirating needle 

 attached to a glass syringe is thrust, in various directions, into 

 the liver substance. Once the abscess cavity is discovered, the 

 needle is withdrawn and a large Ochsner's gall bladder trocar 

 attached to a long rubber tubing is pushed into the abscess cavity. 

 As a rule the thick viscid liver pus flows out freely, but if the 

 flow is sluggish, a large syringe may be used to suck the pus out. 

 With a little pressure exerted upon the abdomen to cause the 

 intestines to push up against the inferior surface of the liver, 

 the abscess cavity may be completely evacuated; however, com- 

 plete evacuation is not necessary. Immediately after withdraw- 

 ing the trocar, one end of a piece of rubber tubing, slightly larger 

 than the trocar and 60 to 70 centimeters long, is introduced into 



