Erysipelas not infrequently involves the abdominal surface, and, spreading deeply, may produce suppuration or a virulent type of peritonitis. The latter is more likely to occur in connection with wounds and other injuries.
Aside from burns of the minor type, which may involve large areas, there may be seen, especially upon the abdomen, extensive and distressing expressions of x-ray dermatitis, so called, followed by ulcerations, perhaps with the later development of epithelioma. These results of injudicious exposure to the cathode rays are always of the most painful and erethistic type, and most difficult to heal. Resistant cases are probably best treated by complete destruction of the surface with knife or spoon and skin grafting.
Upon the abdominal surface are seen some of the characteristic expressions of the ulcerative syphilide and of tuberculosis of the skin. The former will require active antispecific medication and the latter call for the curette or complete excision. In either case radical treatment is usually promptly successful.
Actinomycotic lesions are also seen, perhaps as often about the abdomen as anywhere. They are likely to be mistaken at first for tuberculous or syphilitic disease, but may be differentiated by appearances elsewhere noted. They require active eradication, combined with the local and general use of iodine and copper sulphate.
TUMORS OF THE ABDOMINAL WALL.
The abdominal walls are not exempt from tumors which involve similar textures in other parts of the body. About the ordinary hernial outlets it is advisable to proceed cautiously with any tumor, lest it may prove to contain or to be combined with a true hernia in disguise. This is especially true at the umbilicus. Congenital cysts in the walls are usually met with along the middle line, and will prove to be remnants of embryonic cysts, vitello-intestinal, urachal, echinococcus, or dermoid. Cysts should be distinguished from fatty tumors and sometimes from hernias or from cold abscesses.
Fatty tumors are common in all shapes, locations, and sizes. Among the benign tumors frequently observed are the fibromas, especially those of the type spoken of in Chapter XXVI as desmoids—i. e., those arising from the dense, fibrous, aponeurotic tissues, growing slowly, being exceedingly firm and hard in character, intimately connected with the fascia or aponeurosis, but not with the overlying skin nor with the viscera beneath. They are practically painless, may attain great size, and should always be removed while yet small, in order that the abdominal wall may not be weakened more than necessary by taking away the fibrous structures which especially give it strength.
The vascular tumors which call for surgery are uncommon. Pigmented nevi, however, are occasionally met, and these should always be promptly removed lest they degenerate into melanosarcomas. Varices and venous angiomas, sometimes of extensive dimensions, are also not infrequently found here. Extensive varicosities may have a congenital cause, the deep venous channels being insufficient, or they may be due to thrombotic occlusion of the abdominal veins following typhoid, puerperal fever, or injury.
Primary carcinoma originating within or upon the skin, epithelioma of similar origin, and sarcoma arising from the deeper mesoblastic tissues, may occur as primary tumors of the abdominal wall. We may also have endothelioma springing from the peritoneum, with possible origin elsewhere. Occurring secondarily we may see any of the ordinary metastatic expressions of any of these forms of growth, as well as those spreading by continuity, the most frequent example of the latter being so-called cancer en cuirasse following cancer of the breast.
Finally, for those enormous overdevelopments of fat and connective tissue which accompany exceedingly pendulous abdomens, such as most commonly follow pregnancy or elephantiasis, the surgeon has occasionally to excise large areas, closing the defects thus made by numerous tiers of buried with strong superficial and retention sutures.