GLUTEAL ABSCESS WITH ANEURISM OF THE SCIATIC ARTERY. /'

V By H. R. BUTTON,

LIEUT,, I,M.S.,

Mcdl, Ojfr.t Sth Rajputs, in charge Cantonment Hospital, Barrackpore.

A Kuviraj, aged thirty, was admitted to the Cantonment Hospital suffering from pain and swelling in the right buttock. He was carried to the hospital as he could neither walk nor

stand, and his right leg was kept straight, as he was unable to flex his thigh. He had suffered with this for two months and had seen various native doctors and others without any relief

having been obtained. He said he had never had a fall, strain, or other injury on the site of the present pain. He was very emaciated and

debilitated, but there were no signs of tubercle present and no history of any. On primary examination the right buttock

was found to be considerably enlarged and

rounded, and the skin over it distended and

shiny, but with no special spot of redness or bulging discernible. The swelling was greatest between the great trochanter and ischial tubero- sity and extended to within one inch of the iliac crest. A sense of heat was present, and he com-

plained of great pain on pressure. Fluctuation was with difficulty obtained. The thigh was kept extended and absolutely rigid. Temperature at night 100.? The next day he was prepared for operation and placed on the table, and under the anaesthetic the limb could be rotated and extended but only slightly flexed. With ah

exploring needle pus having been found, I made a vertical incision two inches long through the skin and*superficial and deep fasciae and opened up the pus cavity by Hilton's method. About one pint of slightly sanious pus was evacuated. I then explored the extensive cavity towards the hip-joint and neck of femur, but found them normal. Suddenly a very severe arterial

haemorrhage occurred, so I packed the whole

cavity tightly with gauze, the patient's condition at that time not warranting any further opera- tion. He recovered well from the anaesthetic. The next day about 32 hours after the operation he complained of great pain, so I removed the

packing and irrigated the cavity and repacked it. The wound continued to discharge a great deal of sanious pus daily. On the eighth day severe haemorrhage occurred, so I packed the

cavity again tightly, but the next day haemorr- hage having recurred, I decided to cut down and t.ie the gluteal artery if I could not find the bleed- ing point. This latter I could not do, so I tied the gluteal artery at the upper part of the sciatic notch. In spite of this the haemorrhage continued, and exploring carefully with the

finger, in the lowest part of the first incision, I found a sacculated aneurism of the sciatic

artery about the size of a pigeon's egg. I passed two pairs of Spencer Wells' forceps over the sac

and the haemorrhage ceased. The patient's pulse was weak, so I rapidly closed the second incision and packed the whole cavity lightly. The

forceps were removed at the end of 36 hours and the cavity gently irrigated aiM a gauze drain inserted. Two days later all discharge ceased, the second incision healed by first inten-

tion, and the cavity filled up, and the patient was discharged completely cured eighteen days after the second operation, with full use of his leg again.