A case of volvulus of the small intestine at a Meckel's diverticulum : together with some observations on 'subacute ileus' and the performance of gastrostomy for paralysis of the small intestine / by K.G. Lennander.

  • Lennander, Karl Gustav, 1857-1908.
Date:
1907
Catalogue details

Licence: In copyright

Credit: A case of volvulus of the small intestine at a Meckel's diverticulum : together with some observations on 'subacute ileus' and the performance of gastrostomy for paralysis of the small intestine / by K.G. Lennander. 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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    patient, or suddenly and unexpectedly, may lead to occlusion of the intestine. If it be impossible to arrive at a quick and debnite diagnosis liy the aid of the previous history and present condition, a diagnosis ex adjuvantihis thempicc must at once be resorted to. If you are certain to do no damage by these measures, you may give gasti'ic and intestinal irrigations in quick succession. F. Lcjahrs claims to have found great benefit from the electric enema.^ If by these means the physician during the course of one to three hours cannot secure a free escape of flatus per anura, the patient should be transferred to a surgical hospital, where in the meantime everything is got ready for operation. Should the diagnosis be still uncertain, or there is not sufficient indication for an immediate operation, another attempt may be made to give relief by gastric and rectal injections under the control of the surgeon. If the desired result be not obtained, operation is then resorted to without delay. The practitioner must understand that it is his duty to hand over to the surgeon a patient with an inflammatory or mechanical obstruction before that part of the bowel lying above the obstruc- tion is damaged by distension and hy the accuimdation of intestinal 2)oisons and bacteria. I said inflammatory or mechanical obstruction to the ])assage of the intestinal contents. I want to call attention to the fact that paralysis of a portion of a coil of intestine due to peritonitis causes, as long as the paralysis lasts, just as insurmount- able an obstruction to the onward flow of the intestinal contents as, for instance, a Amlvulus of the bowel. If we now think of our patient with the volvulus of the small intestine associated with a Meckel’s diverticulum, the previous history pointed to appendicitis, whereas the superficial and tender resistance at the umbilicus spoke against this diagnosis. It was also remarkable, as I have already stated, that in presence of this resistance and a perfectly afebrile condition, the abdomen became more and more distended, the patient suffered from nausea and eructations, and no flatus was passed by the anus. In my opinion, this patient should have been sent to a surgical hospital during the first afternoon, 8th January, as a case of mechanical obstruction of the bowels. If the patient and the doctor had been doubtful on the 8th of January, careful, repeated irrigation of the stomach and of the colon would no doubt have convinced both of the presence of a “ stop ” somewhere. All medical men with practical experience agree that in a case of volvulus of the small intestine it is possible at the beginning of the illness, before there is paresis of the afferent portion of bowel, to empty the bowel above as well as below the obstruction fairly well by means of gastric and intestinal irrigation. * F. Liyahrs, “Technik dringliclier Operationen,” 1906, Anil. 3, S. 46-1.