New operation for rupture of the perineum through the sphincter / by J. Collins Warren.

  • John Collins Warren
Date:
1883
Catalogue details

Licence: Public Domain Mark

Credit: New operation for rupture of the perineum through the sphincter / by J. Collins Warren. 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 weak point of every operation hitherto devised lies in the management of the rectal wound. The perineal body is not situated in front of the rectum, but forms, as it were, the floor of that cavity, which at this point takes a sudden curve backward to reach the anal orifice. A freshly united linear rectal wound at this point must, therefore, present itself at right angles to the axis of the rectum, and must sustain the full force of a column of gas or feces coming down from above. If the wound be a long one and the perineal body not sufficiently thick, the point of least resistance will be in the direction of the vagina, and a recto-vaginal fistula may result. Emmet, who, it must be acknowledged, has done more than any other surgeon to place this operation upon its present comparatively firm basis, has sought to overcome this source of danger by drawing down the edge of the septum to the sphincter muscle by means of his bag-string suture, and thus do away with a rectal wound as completely as possible. The moment, however, the edge of the septum has been re- leased from its cicatricial bands by the scissors, it begins to withdraw itself to its original position ; a point much fur- ther inside the pelvis than one would imagine who judged by its position in the cicatrized state. The tension of the recto-vaginal septum when drawn still further down by the bag-string suture is greatly increased, and displays itself first when the parts have become swollen by inflammation, the lower stitches being frequently sucked up, as it were, into the rectum ; later, when the tissues are softer, the stitches cut through and the rectal wall retracts, forming an open wound in the rectum and exposing the lower portion of the perineal body. If we extend the line of the axis of the rectum downwards through the perineal body, we shall find that it emerges usually between the second and third stitches externally. It is at this point that the contents of the rectum force their way out, so far as the writer’s experi- ence goes, and establish a fistulous opening around which the freshly united tissues gradually melt away. The prin- ciple of the method described in this article consists in
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