REMOVAL 
OF AN 
OVARIAN CYST 
WEIGHING ONE HUNDRED AND SIXTEEN 
POUNDS. RECOVERY. 
BY 
HOWARD A. KELLY, M.D., 
Philadelphia, Pa. 
Reprinted from the American Journal of Obstetrics and Diseases 
of Women and Children, VoI. XYIII., August, 1885. 
NEW YOEK : 
WILLIAM WOOD & COMPANY, 56 & 58 LAFAYETTE PLACE. 
1885. REMOVAL 
OF AN 
OVARIAN CYST 
WEIGHING ONE HUNDRED AND SIXTEEN 
POUNDS. RECOVERY. 
BY 
HOWARD A. KELLY, M.D., 
Philadelphia, Pa. 
Reprinted from the American Journal of Obstetrics and Diseases 
op Women and Children, VoI. XVIII., August, 1885. 
NEWYORK : 
WILLIAM WOOD & COMPANY, 56 & 58 LAFAYETTE PLACE. 
1885. AN OVARIAN CYST WEIGHING ONE HUNDRED AND SIXTEEN 
POUNDS SUCCESSFULLY REMOVED. 
It is now more than a year since I operated on the patient, 
the subject of this paper. 
Mrs. T., a widow, 42 years of age, menstruated first at 12# 
years, was married at 21, and lias had four children at full term 
Her menstruation has always appeared every four or five weeks’ 
lasting from three days to a week, and been moderate in amount 
and painless ; of late she has menstruated every two weeks. 
After the birth of her first child, fifteen years ago, it was 
noticed when she left the parturient bed that her abdomen was as 
large as before. Her health, however, continued perfectly good 
until three years ago, when she was treated in the ward of the 
Episcopal Hospital for malaria, when the tumor was noticed by 
the doctor and examined. 
The growth was gradual, and accompanied by occasional sharp 
pains in the left inguinal region until four months ago, when she 
fell down eight steps, since which time she has greatly swelled 
and suffers frequently from orthopnea, distressing retching, and 
constant wearing pains in the back and hips. Her face has a 
typically wasted drawn look, characteristic of many night watches 
spent at the window. The skin is dry and the limbs shrunken. 
The belly is enormous. It measures forty-four and a-half inches 
in circumference as she lies on my office chair. It is very pen- 
dulous, pouching down, measuring fifteen inches from ensiform 
cartilage to navel, and nine inches from navel to pubes. The 
skin is full of lineae albicantes, edematous beneath the pouching, 
and traversed by conspicuous superficial abdominal veins, which 
course down to the superficial circumflex veins of the thigh. 
Fluctuation and lateral resonance not changed by posture, with a 
left latero-flexed uterus seemingly in close connection with the 
tumor, pointed distinctly to the diagnosis, which was completed 
by aspirating thirty minims of the fluid, which was found to be 
opalescent, viscid, full of albumin, and, under the microscope, 
full of compound and large granular cells. 
After a suitable preparation of the room, and with the instru- 
ments immersed in a two and a half per cent solution of carbolic 4 
Kelly : A Large Ovarian Cyst 
acid, I proceeded to operate at 3 o’clock p.m., on June 7th, 1884, 
assisted directly by Drs. Jos. Price and B. A. Eandall. There 
were also present Drs. A. K. Minich, S. T. K. Morton, Geo. 
Boyd, E. F. Walsh, and others. 
The tumor was evacuated through an incision about five inches 
in length. Two veins required clipping in the skin. The sac 
was exposed, and found to be universally adherent to the ab- 
dominal parietes. 
A few of the largest cysts were immediately evacuated by a 
Hodge trocar, and an hour was then consumed in working up 
between the adhesions and the belly wall; in some places the 
union was so dense as to require considerable dissection with a 
scalpel to free the mass. 
As the sac was gradually drawn down, a large rounded hard 
mass about the size of the liver emerged from under the right 
hypochondrium, which became tympanitic resonant upon its with- 
drawal. This was believed to be the liver, and Dr. Randall’s 
attention was engaged in detaining it, as I gradually dragged the 
cyst out until finally, much to our consternation, it suddenly 
slipped from under his fingers and delivered itself at the opening, 
where it looked like an enormous cystically degenerated kidney. 
The cysts were full of glutinous and purulent material, and the 
whole mass was but a part of the ovarian growth. By dint of 
slow hard work, with both thumbs opposed, the whole sac was 
gradually freed from the belly wall to Avhich it was universally 
adherent, and the pedicle reached at the left broad ligament. 
This was tied through the ampulla by a Thomas’ knot and drop- 
ped. Not a single ligature was used for oozing or bleeding beside 
that on the pedicle, the method of separation and the time con- 
sumed acting as efficient hemostatics. The toilet was made with 
the utmost care, and upon closure of the wound, a curved drain- 
age tube six and a half inches long with a lip and a lumen of a 
half-inch was inserted behind the uterus. The sutures of silver 
wire included one-half inch of peritoneum on each side. The line 
of the wound was dried and sprinkled thick with powdered iodo- 
form. The tube was plugged with carbolized gauze, and a few 
layers of gauze covered the whole, held in place by a bandage. 
The whole operation lasted over two hours. She was badly 
burned by two of the hot bottles placed around her, and the 
sloughing of the leathery skin and suppuration troubled her long 
after recovery from'the operation. 
There was some shock and vomiting the night following the 
operation. She was allowed a tablespoonful of cold tea every 
half-hour for the first twenty-four hours, after which she took 
beef-tea and wine-whey, and beef-tea by enema. 
Her pulse remained pretty constantly at 132 until the sixth day 
after the operation, when it was 108, below which it did not go, 
although from that day on she visibly improved, “ feeling stronger 
every day.” Successfully Removed. 
5 
The temperature ranged from 100 to 101°, dropping to 99° on 
the fifth day, when all the stitches were removed, and union 
found perfect. 
I do not include my full record of the temperature, as it was 
manifestly complicated by the severe burn on the side. The 
wound healed up to the tube by first intention. There is one 
point in the after-treatment to which, in the light of my ex- 
perience then and subsequently, I attribute much importance ; 
that is, having cleansed the peritoneum and inserted a large 
drainage tube, I adopted measures to keep it clean. The day 
following the operation I drew off, by means of a long nozzle 
syringe reaching to the bottom of the tube, seven ounces of thin 
claret-colored fluid, and in the evening of the same day washed 
ont the pelvis with a, one and one-half per cent carbolized solution 
by passing in a rubber tube attached to a gravity syringe. This 
washing was continued twice daily, about a pint of fluid being- 
used each time. 
It was a source of the greatest relief to her ; and invariably 
when I found her flushed and restless, the washing left her com- 
posed and comfortable. 
On the 9th inst., decolorized blood-clots began to pass out 
with the washing, and the note on the 10th states that sev- 
eral ounces of curdy matter and serous fluid were brought 
away. 
On the 11th, there was a free metrostaxis, and many pinkish 
curds were .washed out until the fluid returned clear, which latter 
was the only rule for discontinuance of the washing at each 
sitting. On this day, I observed for the first time a very hard, 
semi-circular mass, from two or three inches broad, extending 
from the right hypochondrium across well above the navel, into 
the left hypochondrium, and then vertically downwards into the 
left iliac region. This felt exactly like the hard mass of a tumor, 
and seemed to be in the muscles of the belly wall. It corresponded 
to the points of closest adhesion of the sac, and remained for many 
days, gradually melting away. 
The bowels were easily moved for the first time two weeks after 
the operation, at which time she was enjoying an enlarged diet 
list, sitting up and feeling well. The length of the incision, six- 
teen days after, was three inches, about which time the drainage 
tube was removed, as but a small quantity of thin pus continued 
to run out of the lower angle of the wound. The note on the 12th 
of August says : 
“ Still a few drops of sero-pus exude from lower angle of the 
wound daily. Burns almost closed in. Well and hearty, looks 
ten years younger, has a bright color, and a very happy expression 
in place of the facies ovaria7ia.” 
She menstruated six weeks after the operation, losing but a 
little pale fluid by drops, but suffering from the same severe 
cramps during the week which she had had previously. 
How, a year after, the menstruation has been regular, painless. 6 
Kelly : Large Ovarian Cyst Successfully Removed. 
and perfectly natural, lasting three days. She is in perfect health, 
working hard in a mill, and the scar is almost invisible, the only 
trace of it being a broken, fine white line, with a shallow pit at its 
lower end. 
The tumor was weighed en masse in a tub in the presence of 
Dr. Walsh. The whole weighed 132 pounds, of which the tub 
weighed 16, leaving a weight of 116 pounds for the weight of the 
tumor. I had fully counted on preserving this interesting- 
specimen, but I had scarcely turned ray back to give some neces- 
sary directions about the patient, when the nurse had emptied it 
and some valuable sponges down the privy well. 
It is, I believe, the largest tumor ever removed successfully in 
Philadelphia. 
In Spencer Wells’ list of one thousand ovariotomies, there 
was but one tumor weighing over one hundred pounds. 
Case No. 564 was a single woman, 53 years of age, from 
whom a tumor weighing 125 pounds was removed in June, 
1873. She recovered, and was heard of in 1881. 
In the third edition of Dr, Emmet’s book, “ The Principles 
and Practice of Gynecology,” p. 707, is given the account of 
the largest tumor Dr. Emmet says he ever removed. The 
operation lasted two hours and a quarter, prolonged, as in my 
own case, by extensive parietal adhesions. The tumor weighed 
seventy nine pounds. The patient recovered. 
Dr. Emmet also states that Dr. Keith “ removed one weigh- 
ing 120 pounds, the largest ovarian tumor ever removed suc- 
cessfully from the living body.” 
A. Courty, in his“Prac. Treatise on the Dis. of the Ut., 
Ovaries, and Fal. Tubes” (.Am, Gyn. Trans., Phila., 1883, 
p. 744, says: “ The weight of the tumor has been known to 
exceed 165 pounds ” (Kimball).