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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    2G should be made in the left iliac region, through which, after the peritoneum was di- vided^ the sigmoid flexure of the colon might be withdrawn and opened. He further pro- posed to retain the intestine in the vicinity of the external wound by a ligature passed through the mesentery, which should be al- lowed to remain a few days, until the bowel had become united by adhesion to the exter- nal wound. The operation, according to Littre's plan, was first practised, without success, by M. Dubois', in 1783, and successfully by M. Duret2, in 1793, in the following case. An infant, in whom there was no appearance of anus, the skin being firm and thick, and extending across the situation of this aperture, was brought to M. Duret thirty- four hours after birth ; at which time it was Buffering from distension of the abdomen and frequent vomiting; the extremities were cold, and death appeared to be impending. He made an unsuccessful attempt to relieve the patient by incision in the perineum, and then determined to open the abdomen at the left iliac region. Having found the sigmoid flexure of the colon, he retained it near the wound by two threads passed through the mesentery, and made an opening in it of sufficient size to allow of the free escape of its contents. The suffer- ings of the little patient were relieved, and it daily improved in health. After a few days the strings were withdrawn ; and on the seventh it was restored to the care of its parents. At the age of eleven years this child was living at Brest. The iliac operation, in a modified form, was performed by Pillore, who united the wound of the intestine to the parietal wound by several points of suture. The iliac operation has since been per- formed in numerous instances. From the fol- Fig. 11. Pit/ore a operation for iliac artificial anus. Sectio?i of the ccecum. After liouryery. 1 See Dirt. <le Med. et de Cliir. Pr. t. iii. p. 128. s Bectteil periodique dc la Societe de Medecine dc Paris, t. iv. p. 45. lowing table, which contains twenty-four cases it appears, that, in eighteen instances, the operation was performed on infants for an im- Fig. 12. Pillore's operation completed. The. wound in the intes- tine united to tlie wound of the integuments hy sit jiuinls of twisted suture. After Bowrgery. perforate condition of the anus or rectum, and in seven of them with success. In one case, a irirl aged four years, successfully underwent the operation for the relief of malformation. The other five operations were performed upon adults, for the relief of obstruction from tumour, carcinoma, or other cause not ascer- tained. Two of these cases proved successful ; the others were attended with a fatal result on the second, fourteenth, and twenty-eighth days. Cases in ivhich the operation for establishing an iliac artificial anus was performed. PlI.I.ORE. 1776. Amussat's Memoire sin la possibilite d'etablir un Anus artifi- cicl, &c. p. 85. Adult male. Schirrous indura- ion of tlic lower oart of the colon, and upper part of rectum. (Isecum opened ; odjjes of intestinal wound united by suture to the inte- guments. Perito- nitic symptoms on the 20th day. Death on the 28th day. Dubois. 1783. BecUeil peri- odique de la Societe dc M edecine de Paris, t. iii. p. 125. Imperforate anus. Littre's operation. Death in 10 days. Doubt. 1798. Rccucil pe- riodique de la Societe dc Medecine dc Paris, t. iv. ]). 45. Imperforate anus. Littre's operation. The subject of this operation was liv- ing at the age of 11 years. Desault. 17!i4. Journal de Cliir. t. iv. p. 248. Imperforate anus Death in 4 days.
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