An essay on intestinal fistula / by Thomas Pridgin Teale. From the second volume of "The cyclopedia of practical surgery".

  • Thomas Pridgin Teale
Date:
1841
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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.

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    6 weeks afterwards his hernia began to swell, and to become painful. An abscess formed, which soon burst, and the point of a pin appeared projecting from the orifice. The pin was extracted, but the fistulous opening remained. Attempts were made to unite it, by paring the edges of the wound, and encou- raging adhesion, but without success. A woman, fifty-eight years of age, was treated by M. Bougon1 for an inflammatory tumour of the right iliac region, which had existed fifteen days. The swelling broke, and discharged fetid pus, air, mucus, and feces ; subsequently a portion of bone, supposed to have belonged to the head of a fish, was dis- charged. On the forty-third day the opening had spontaneously closed. See Foreign Bo- dies. A scrofulous girl was admitted into the hospital La Pitie, under the care of M. Vel- peau, on account of a fecal discharge from the navel, following an inflammatory swelling at the part which had been opened. She died of phthisis about ten weeks after the occur- rence of the discharge from the wound. During the whole of this period she had eva- cuations by the natural passage, and some discharge from the wound ; a sinus near an inch in length was found to communicate with the intestine, and no obstruction existed in the canal. M. Velpeau2 also relates the case of a youth of seventeen, who had for several months been under the care of M. Louis for symp- toms of intestinal ulceration. An abscess formed, which was followed by a fistulous ulcer below the navel, from which feculent matter was discharged. The discharge of feces by the natural passage had never been completely interrupted. The health in other respects was good. M. Velpeau opened a long sinus which led to the right iliac fossa, and was thus enabled to introduce the finger into the bowel, which he concluded to be the coecum or ascending colon. Fluid injected as clyster, as well as articles of food, soon appeared at the abnormal opening ; but when the aperture was closed by a compress, the motions were passed naturally. Repeated efforts were made to close the opening by suture, simple and twisted, and thrice by auto- plasty, but without success. A valve, felt at the opening, was destroyed by the entero- tome of Dupuytren, without any better result. On comparing intestinal fistula from ab- scess with the same affection following gan- grenous hernia, it appears that these affec- tions resemble each other in the accompany- ing adhesive process, whereby feculent effu- sion into the peritoneum is generally pre- vented ; but fistula from abscess differs from the other variety of the affection in the absence of the membranous funnel, which has been shown to perforin so important a part in 1 Journal Hebdomadaire, Juillot, 1836. 2 Journal Hebdomadaire, Juillet, IH.'Sfi, quoted by Mr. Lawrence in Ma Treatise on Ruptures, p. 42/ Ath edit. restoring the continuity of the intestinal canal, when more or less of this tube has been destroyed by gangrene. In fistula following abscess, this provision is not required ; for the loss of substance in the intestinal walls is seldom so great as materially to interfere with the dimensions of the canal. Hence the obstruction from the projecting valve, and the subsequent necessity for retraction of the in- testine and the valve, to which process the membranous funnel was subservient, does not usually exist. Notwithstanding this compara- tive immunity from obstruction of the canal, a cure, either spontaneous or artificial, does not appear to be so generally accomplished in this variety of fecal fistula, as in that which re- sults from gangrenous hernia. III.—Intestinal Fistula following pene- trating Wounds of the Abdomen. Wounds penetrating the abdominal walls, and implicating the intestines,are occasionally, but not generally, followed by escape of feces. The circumstances under which the wounded intestine discharges its contents by an abnor- mal aperture, are so variable, that it will tend much to the elucidation of the subject, if we separately consider fecal fistula as a conse- quence of (i.) Incised1 wounds of the abdomen. a. Without ])rotrusion of the bowel. b. With ]wotrusion of the bowel. (ii.) Gunshot wounds. Fecal Fistula from incised Wounds unat- tended with Protrusion of the Bowel.—It has been shown by Mr. Travers that feculent effusion into the peritoneum is a very rare consequence of punctured and incised wounds of the abdomen ; and so also an external discharge of the intestinal contents is not the usual, but only the occasional, result of such injuries. Internal effusion is prevented by the pres- sure which the respiratory muscles exercise upon the abdominal viscera, aided by the mechanical closure of the wound in the intes- tine, from eversion of its mucous membrane, and contraction of its muscular fibres. These agents are effectual, unless the wound be large, and the intestine loaded, or there bean inter- posed fluid in the peritoneum The same causes also prevent the escape of alimentary matters from the external wound, unless the opening in the intestine remain in direct ap- position with the breach in the abdominal walls, when the intestinal contents usually escape, without insinuating themselves into the divided peritoneum. When, however, fecal (liseharge occurs, the adhesive process in a few hours agglutinates the edges of the intestinal and parietal wounds ; the peritoneal cavity is closed ; and the intestinal contents 1 Incised is here employed to designate wounds inflicted by cutting instruments, as distinguished from tbose produced by fire-arms. It therefore applies to such wounds as are technically denominated punc- tured,''as well as to those usually denominated in- cised.
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