An essay on intestinal fistula / by Thomas Pridgin Teale. From the second volume of "The cyclopedia of practical surgery".
- Thomas Pridgin Teale
- Date:
- 1841
Licence: Public Domain Mark
Credit: An essay on intestinal fistula / by Thomas Pridgin Teale. From the second volume of "The cyclopedia of practical surgery". Source: Wellcome Collection.
Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.
12/46 page 6
![but connected to them by a fibro-cellular cord, which constituted the sole remnant of the adhesions formerly uniting- them. Various agents are supposed to assist in pro- ducing- this retraction. The intestinal con- tents in passing over the projecting- ridge act upon it, and gradually diminish its promi- nence, pushing it back with a force propor- tioned to the resistance which they experi- ence to their escape through the narrow wound in the abdomen. The peristaltic movements, and the more extensive undula- tions of the entire canal, are supposed by M. Dupuytren 1 to contribute to the loosening and elongation of the adhesions, which con- nect the opened part of the intestine to the surface of the cavity. A third circumstance, even more powerful than the former, co- operates with them in producing these effects. The mesentery connected with the opened portion of intestine is stretched and thrown into folds between its lumbar attachment, and the bowel. In many hernia? this extension of the mesentery is so considerable as to keep the body bent forwards ; and in abnormal anus, this mesenteric cord is constantly draw- ing the intestine towards the cavity. The following case, observed by M. Wedemeyer 2, exhibits another agent which may occasionally tend to produce the same effect. A female had femoral hernia, followed by fecal dis- charge from the groin. After various means of cure hail been tried in vain, the opening spontaneously closed during utero-gestation. As the uterus ascended in the abdomen, the escape of matters from the accidental opening diminished, and there was a corresponding increase of natural evacuations. As the intestine becomes retracted within the abdomen, the adherent neck of the sac is drawn with it ; and the funnel-shaped cavity which it now constitutes, and which separates the ridge from the opening in the walls, is ex- tended. Thus the intestinal contents find, in front of the ridge, a space gradually becoming larger, through which they have a more easy passage from the upper to the lower part of the intestine ; they are at the same time directed with less force towards the external opening, and thus allow the wound of the integuments to contract and ultimately to close. The following table exhibits eleven record- ed cases, taken indiscriminately, in which the feculent discharge following gangrenous her- nia spontaneously ceased. In eight of these cases, the time when the cessation occurred is specified, and is found to vary from thirteen to seventy days ; or, on the average, to be thirty-nine days. Some further lapse of time was requisite for the perfect cicatrization of the wound. The quantity of intestine destroyed is not in all the cases noted ; but in some of them the gangrene must have implicated a few inches of the tube ; and in the instance related by Scarpa a long loop of intestine was lost. 1 Op. citat. p. 137. 2 Diet, de Med. et de Chir. Prat. t. iii. p. 138. Table exhibiting eleven cases hi which Ike fecu- lent discharge following gangrenous hernia spontaneously ceased. REFERENCE. extent OF intes- tine destroyed. DURATION OF FE- CULENT DIS- CHARGE. Petit. Tract, des Med.& Chir. p. 299. Incision 1 inch in tlic mortified intestine. In 13 days feces ceased to pass by the wound. (iOOCH. Works, vol. ii. p. 197. Incision 2 or 3 inches long in the mortified intestine. In 10 weeks feces ceased to pass by the wound. Travers Inquiry, &c. p. 317. Free opening made in the mortified gut. Feces generally took their natural course in (> weeks, mid in 11 weeks 1 h< wound was healed. Scarpa. Wishart's Tr. p. 301. Long loop of spha- celated ileum cut away. On the42dday the wound was nearly cicatrized. Petit. Trait e dcs Med. Chir. p. 317. Intestine and scro- tum gangrenous. Free incision. Feces ceased to pass by the wound on the 28th day. Petit. Traite des Med. Chir. p. 321. Intestine free!) opened by gan- grene. On 1.9th day feces ceased to pass by the wound, which was nearly healed on the 22d day. Louis. Mem. de 1' Acad.de Chir. t. iii. p. 199. Intestine and inte- guments extreme- ly gangrenous. Fecal discharge from the wound ceased in 1 month. Poi'SARDIN. Mem. de 1' Aead.de Chir. t. iii. p. 203. Intestine gangren- ous; integuments opened by ulcera- tion. Fecal discharge ceased in 6' weeks. POUSARDIX. Mem. de Y A ca d. de ( Ihir. t. iii. p. 203. Intestine gangren- ous ; sac filled with fprnlfiit llnttpv i < < 11 j iii 111.1111. i . Fecal discharge ceased in 2 months ■i ii il *i Ii •! 1 f* till U *l 11.111. Lanzoni. Mem. de V Acad.de (Ihir, t. iii. p. 204. Small loo]) of in- testine gangrenous. Wound cicatrized in 20 days. COOI'ER. 2d edit. p. 572. Incision \r, inch long in gangrenous intestine. Wound healed in 11 weeks. In operating for strangulated hernia, the surgeon occasionally observes the intestine to be congested or inflamed, but in such a degree as not to preclude the hope of its resuming a healthy condition. He returns the bowel into the abdomen, and, in a few days, feculent matter appears at the wound. After a time the discharge of feces generally ceases, and the wound cicatrizes. The subjoined table exhibits seven cases of this description. In six the discharge appeared at the wound at periods varying from the third to the fif- teenth day, or, on the average, on the eig'hth day ; and in one instance it did not occur until the forty-second day. In four the dis- charge continued only from three to twenty- one days ; in one seventy-seven days ; and in the case where the discharge first' appeared](https://iiif.wellcomecollection.org/image/b21525985_0012.jp2/full/800%2C/0/default.jpg)
