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.

    13/16 (page 29)
    T consider that the cause of death in this case was diphtheritis of the intestine and toxajniia. It is probable that the illness from whicli the patient suffered during April and ]\Iay 1905 was an inflammation of Meckel’s diverticulum, and not appendicitis. The diverticulum was now enlarged in its umbilical portion to a so-called entero-cystoma, tilled with pus and fieces, and showing ulceration of its mucous membrane. As a result of the twisting of the small intestine, the healthy dilated portion of the diverticulum also became twisted, and thereby its contents were shut off from the rest of the intestinal canal. As the whole of the anterior surface of the cyst was adherent to the anterior abdominal wall, behind and to the right of the umbilicus, a quite superficial tender resistance could be felt already, a few hours after the onset of the attack. The tenderness, on pressure, increased both as regards intensity and extent, and at the operation an abundant extra- peritoneal oedema was found. In this case, the colon aiid meso-colon to the right of the middle line had never become fixed to the posterior abdominal wall, but the colon, together with the caecum and the small intestine, was attached to a mesentery, which was quite free, and hung down from the bodies of the vertebra;, common to both small and large intestines. This congenital malformation accounts for, on the one hand, invagination of the ileum, caecum, and colon ; on the other hand, volvulus of a smaller or greater portion of the small intestine, together with the caecum and the right colon. How easily such a twisting may occur is shown by this case, where, during the untwisting and emptying of the small intestine, the cacum and ascending colon had become twisted a whole turn. In my opinion, a typhlostomy in the anterior tania of the cacum would be an easy and effective way of preventing a recurrence of the twisting. Besides this, my intention with this oblique fistula was (1) to facilitate the emptying of the ileum, and (2) to allow the intro- duction of water and nourishment after the operation, until the small intestine had regained its contractile power. I have previously pointed out^ that if paralysed intestine, even after being partially emptied of its contents, cannot be replaced in the abdominal cavity, the best plan is to keep the wound open, and to leave those coils of intestines outside. I did so in this case; next to the intestine 1 placed a smooth rubber sheet, fastened by means of catgut sutures to the edges of the parietal peritoneum. Outside the rubber was put a large sterile, absf)rbent dressing, fastened to the abdominal wall by means of broad pieces of strapping, and outside of this a thick layer of * See, forin.stance, my introductory paper to the discussion on Acute Peritoniti.s, at the International Surgical Congress at Bruxelles, 1905, Edin. Med. Journ., 1905, vol. xviii. pp. 105, 237.