This section is from the book "Anatomy Of The Arteries Of The Human Body", by John Hatch Power. Also available from Amazon: Anatomy of the Arteries of the Human Body, with the Descriptive Anatomy of the Heart.
A patient in Guy's Hospital had violent bleeding just above the left groin, from an aneurismal tumor of the external iliac artery. The integuments had sloughed, and the patient was exceedingly reduced from loss of blood. Under these circumstances, and finding it impossible from the size of the tumor to secure the iliac artery, Sir A. Cooper felt justified in tying the aorta. The operations was performed in April, 1817. He made an incision into the linea alba three inches long, allowing a curve in it to avoid the umbilicus. In this manner the sac of the peritoneum was opened, and the fingers were then conveyed to the artery, which was readily distinguished by its strong pulsations. The peritoneum was then lacerated with the fingernail, in order to allow the ligature to be conveyed around it at about three-quarters of an inch above its bifurcation. During the operation the faeces were involuntarily discharged. The patient died on the second day after the operation, and his death is ascribed by Sir A. Cooper to want of circulation in the aneurismal limb; which led him to observe that " in an aneurism similarly situated, the ligature must be applied before the swelling has acquired any very considerable magnitude."* In his Surgical Lectures he observes, "If I were to perform this operation again, the only difference that I would make would be to cut the ligature close to the vessel, where it might take its chance either to be encysted or absorbed." A little farther on he observes, "The principal danger appeared to arise from the irritation produced in the intestines by the ligature; and that is the reason why I would cut the ligature close to the vessel." In dissection there were no appearances of peritoneal inflammation.
* Med. Ch. Trans., vol. ii. p. 158.