Volvulus of giant sigmoid colon : recurrent attacks of acute obstructions, relief by new method / by William B. Coley and I.S. Chaffee.

  • Coley, William Bradley, 1862-1926.
Date:
1909
Catalogue details

Licence: In copyright

Credit: Volvulus of giant sigmoid colon : recurrent attacks of acute obstructions, relief by new method / by William B. Coley and I.S. Chaffee. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    the site of the former incision, which was done without anaesthesia. On opening the sigmoid a very large amount of flatus was ex- pelled and some fecal matter. The absence of any tumor—the abdomen being flat—and his good general condition led us to be- lieve that our probable diagnosis of malignant disease was incor- rect and that we had, instead, a greatly enlarged sigmoid which, when it became distended with gas, produced the condition of volvulus resulting in partial or complete obstruction. If this diagnosis were correct, it occurred to me that keeping a small tube in the opening of the abdomen would make it impossible for the gaseous distention to recur, and thus a recurrence of the condition of volvulus might be prevented. Therefore, after the first few days I removed the larger tube from the wound and inserted three-quarters of an inch of the tip of a No. 14 French rubber catheter, the end of which was attached by a safety pin. The distention never recurred, and the following day, August 9, he had six movements. On August 10, he had none. The pain and discomfort left him; the abdomen was flat and appar- ently normal. On August ii he had four stools of good size and semi-solid in consistence, no fecal matter coming through the wound. From that time on, his movements ranged between one and two a day, and were practically normal in character. There was no further discharge from the colostomy wound, except a small amount of liquid fecal matter which found its way through the small opening in the catheter. If our theory as to the causation of the volvulus was cor- rect, it seemed necessary to continue the wearing of a tube in the old wound, but an opening in the tube that would pennit the passage of air without fecal matter should be sufficient. After various modifications the tube shown in Figure i has been adopted as the most satisfactory. It consists of a silver tube, resembling the end of a No. 14 French catheter, con- nected with a circular silver flange about two inches in diame- ter, which rests upon the abdominal wall. Three-eights of an inch from the tip is a lateral opening only i mm. in diameter, which allows the escape of gas but does not pennit the dis- charge of fecal matter. The tube has been worn up to the present time without any inconvenience to the patient. His general health has been perfect and there has been no recur-
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