Reprinted from the New York Medical Journal 
for February 10, 180 4. 
A CASE OF 
INTRA-ABDOMINAL SARCOMA * 
CHARLES PHELPS, M. D. 
1 present a specimen of tumor which I removed two 
weeks ago, and which was situated partly within and partly 
without the peritoneal cavity. A pelvic origin was exclud- 
ed by gynaecological examination, but its exact location and 
character occasioned some differences of opinion. 
The patient, a woman aged forty-two years, has had no 
serious illness at any time, and, with perhaps the exception of a 
single incident, her history affords no suggestion of the exist- 
ence or development of the disease from which she suffered. 
Eighteen years ago she was startled bv the sudden appearance 
of a tumor in the left abdominal region, followed by local pain 
and by vomiting after the ingestion of food. After three months 
this tumor disappeared. In October last she discovered the 
present tumor in the median abdominal line. Its advent was as 
sudden and unexpected as that of its predecessor, and occurred 
to her while she was standing at the washtub. She was ad- 
mitted into St. Vincent's Hospital three weeks later. It was 
firm, irregular in outline, hard, and freely movable. At one 
* Read before the Society of the Alumni of Bellevue Hospital, De- 
cember 6, 1893. 
Copyright, 1894 by D. Appleton and Company. 2 
INTRA-ABDOMINAL sarcoma. 
point, to the right of the median line, it was adherent to the 
superficial tissues, and the skin was beginning to inflame. It 
was.not tender, but occasioned pain when she moved about. 
She was able to retain only fluid food, and movements from the 
bowels were natural. 
An operation was done on November 21st, four weeks after 
the patient's discovery of the tumor. It was found, on incision 
through the median line, that the growth was in greater part 
intraperitoneal, but involved the abdominal wall from within 
as far as the deep surface of the superficial fascia. The ante- 
rior portion was first removed as a flattened mass from the rec- 
tus sheath. The muscular planes were then pushed aside and 
the remaining portion was circumscribed by an incision through 
the peritonaeum, after the rectus muscle and sheath had been 
cut through above and below. The omentum, which with the 
peritonaeum was incorporated with the tumor, was cut on either 
side, adhesions to the transverse colon and small intestine were 
separated, and the entire mass, including implicated mesenteric 
glands, was enucleated from the mesentery. No portion was 
left behind. This necessitated a loss of peritonaeum of about 
six by four inches The wound was closed without difficulty, 
except that in its center the peritoneal edges could not be brought 
in contact. Recovery has been somewhat retarded by the for- 
mation of parietal abscesses, but has been otherwise Uneventful. 
Subsequent microscopic examination of a portion of the tu- 
mor situated immediately behind the rectus sheath determined 
it to be in part a mixed-cell sarcoma and in part a fibro-sarcoma. 
It seems probable that its origin was intraperitoneal, 
from the fact that its larger portion occupied that position, 
as well as from the further fact that the rectus sheath and 
muscle, though more or less infiltrated, had everywhere re- 
tained their general integrity of outline, which was hardly 
to be expected if they had constituted the elder site of 
disease. 
It is at least possible that the tumor which so suddenly 
appeared and so rapidly disappeared eighteen years previ- INTRA-ABDOMINAL SARCOMA. 
3 
ously may have been only the beginning of this one which 
became evident in October last. This supposition is to 
some extent strengthened by the fact that this tumor, like 
the first, was developed from the left side. If such a 
lengthened period of quiescence is not to be assumed in the 
growth of a sarcoma, it is quite credible that a simple ade- 
noid phlegmasia in the mesentery may have temporarily 
become prominent only to quickly subside, and at an in- 
definitely later period terminate in sarcomatous connective- 
tissue degeneration. Such a history would be not only of 
great interest in itself, But corroborative of our present be- 
lief in the necessity for the earliest practicable removal of 
all analogous as well as heterologous deposits. This is, 
however, only a speculative suggestion, as incapable of proof 
as of refutation.