Diabetes Insipidus

Abstract

On June 24 she was unable to void urine, and required catheterization. The family was opposed to further surgery, so it was decided to try x-ray treatment; although in literature I could find record of only one case having been treated with x-rays. That case was reported by Dr. Edw. A. Bjorkenheim in Acta Obstetricia et Gynecologica Scandinavica, and then the x-ray treatments proved of no value. The patient was turned over to a competent roentgenologist on July 1, and at that time treatments were started. On July 16 she was again operated upon, through a midline incision, under gas and ether anesthesia. Upon entering the abdomen, three distinct and separate tumors were found. The one previously felt in the left lower quadrant was an omental implant, the size of two fists-glistening, grayish white in color, smooth and almost solid, but with some cystic points that bulged slightly. The next was retroperitoneal, laying slightly more to the right of midline, at the level of umbilicus, and adherent firmly to several loops of intestine. This one had several areas, rather darkly pigmented, and more cystic in character. The third one was wedged tightly in the pelvis, and extended up into the abdomen, more on the left. Complete removal was impossible, so the omental transplant was removed for specimen, and the abdomen closed without drainage, extra stay sutures being used in anticipation of abdominal distention. The girl, however, made an uneventful recovery, and healed nicely. Treatments by x-ray were again advised as a last resort, and the patient was once more referred to the roentgenologist. The patient was not seen again until July 25, 1932, when the size of abdomen having decreased perceptibly, and her health having improved, she was able to return to school. She began to menstruate in November, 1931, and menstruated regularly for three months, and then skipped until May, 1932. When seen on July 25, 1932, she was complaining of pain in the right side, and examination showed the abdomen greatly distended by a huge lobulated tumor mass. The skin was tight and showed numerous striae, she was markedly anemic, and sick-looking. By August 15, 1932, the pain was so severe and cramps in the right leg so intense, as to require morphin for relief. Her condition grew rapidly worse, until she expired at 6 p. m. on August 21, 1932. Postmortem.-The parents would consent only to opening of the abdomen. Extremely emaciated young woman, with abdomen distended far beyond size of a full-term pregnancy. Frame appeared as a skeleton, with but slight covering. Abdomen was opened from xiphoid to symphysis, and the abdomen was filled by the two tumor masses described at the second operation. The intestines were all displaced to the flanks, and the omentum was contracted high, and was a contracted lace work of small, pearl-gray tumors, varying. in size from pin point to a marble, most of them being about the size of a grain of wheat and up to that of a pea. The parietal peritoneum was studded by myriads of growths of the same character, so close together that there was not room to place a finger tip without touching one of these growths. The liver was filled with growths, the largest of which was the size of a walnut. The intestines were covered with similar implantations, but smaller, and the mesentery was filled with somewhat larger ones. Upon removing a part of the diaphragm, which was also involved, it was found that some of the growths had penetrated into the chest cavity to involve the pleura, and that the mediastinum was filled with the growths.