Case of strangulated hernia, with perforation of the bowel : in which the occlusion of the aperture by ligature was successfully adopted / by Patrick Henry Watson.

  • Watson, Patrick Heron, 1832-1907.
Date:
1869
Catalogue details

Licence: Public Domain Mark

Credit: Case of strangulated hernia, with perforation of the bowel : in which the occlusion of the aperture by ligature was successfully adopted / by Patrick Henry Watson. 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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    strangulation, and tlie consequent ulceration of the nmoous and muscular tissues of the bowel at the part requiring ligature of the serous coat; (2) the risk of faecal extravasation, in consequence of early separation of the ligature before any satisfactory agglutina- tion of the parts implicated could take place; (3) the increased risk of a septic purulent peritonitis from the presence of a ligature, and, possibly, sphacelating bowel within the cavity of tlie abdomen. In favour of a satisfactory result there were, (1) the position of the aperture in the constricted parts being, as we have seen, close to the mesenteric attachment; (2) the likelihood of an agglutinative peritonitis fixing the affected portion of bowel close to the mouth of the sac ; thus affording it efficient support, and a free external escape for pus or intestinal contents. The procedure by puckering up the serous coat from around the small opening is precisely what should be practised in cases of penetrating wounds of the abdomen, with punctured wound of the bowel, where the application of the liga- ture can be effected without diminishing the calibre of the intestine. The healthy condition of the viscus -wounded in such circumstances makes the probabilities of success much greater than -when the tex- tures, long strangulated in a hernia, are subjected to ligatm*e. This plan of treatment, as adapted to the circumstances of wound in the intestine contained in a hernia, was apparently first suggested by Sir A. Cooper, in the second edition of his work upon Hernia,' where he says, “ A small wound may be inflieted upon the gut by the knife of the operator When this accident occurs, and the aperture in the gut is very small, the surgeon is to' employ a different mode of treatment from that re- quired for gangrened intestine. The aperture, with a small portion of the surrounding gut, should be pinched up with a pair of forceps, and a fine silk ligature, being passed round it, should be secured so as to include the ruptured spot; the intestine should then be re- turned to the mouth of the sac.’’ In the case given by Sir Astley in i illustration of this praetice, and upon which he seems to have oper- < ated himself, lie states that, after tying the aperture with a ligature, he reduced the intestine, and closed the wound with five stitches r and strapping. He says nothing, however, about cutting off’ both *• ends of the ligature close to the knot,—an addition to liis plan of procedure which finds its way into the works of both Mr Teale^ and Mr Erichsen,^ as if it were part of the original proposal. In the case I have narrated, I did not cut off the ligature close to f the knot. Neither did I close the wound. In fact, I attached the divided margins of the sac to the edges of the cutaneous wound, so * as to maintain a patent communication with the cavity of tlie ah- .* domen, and a free cliannel of escape for purulent or intestinal mat- ters. The ligature I purposely left hanging out of the wound, that it might afford a guide for the fmculence, should it escape, dhe S ' 1st part, 2(1 ed., p. 45. * Tcalc on Hernia, p. 134. ® Ericlisen’s Science and Art of Surgery, vol. ii. p. 460.
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