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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    sterile, iion-absorbent cotton-wool to keep the abdomen warm. That under such conditions a commencing, general peritonitis can be cured, is best shown by the necropsy in this case. The peritoneal secretion escapes between the smooth rubber sheet and the edges of the abdominal wound. The adhesions formed between the coils of intestine lying outside the abdominal cavity are much more easily separated than if the bowels are covered with gauze. The intestines lying underneath the rubber sheet sink back into the abdominal cavity as the bowel inside regains its power of contraction, and by emptying its contents becomes less bulky. 1 may remark in passing that I now only tampon the abdominal cavity in cases where I consider it necessary to isolate a small portion of the abdominal cavity. In these cases I tampon with coarse 3-spuu cotton thread. For drainage of the peritoneal cavity I use a thin, smooth rubber sheet, sometimes alone, and sometimes along witli thin, soft rubber tubes. 1 f I resiime what I have learned from this case, and from a case of acute dilatation of the stomach, together with volvulus nf the ileum and the lower part of the jejunum, lately published by me,^ my conclusions would be expressed as follows :— 1. If the stomach or the bowel has been distended to a certain degree, i.c. if the muscular coat has been stretched beyond a certain limit, these organs are unable to contract until they have been partially emptied. It was shown long ago by Blix that striped muscle does not recover its power of contraction after being stretclied beyond a certain point. 2. At the operation the highly distended but not paralysed lunvel looks as if it were paralysed, but if emptied of a part of its contents by means of enterotomy, it soon begins to contract, and is afterwards able to empty the rest of its contents through a fistula. 3. Paralysed bowel does not again contract, even after having been emptied of its contents. 4. If one wishes to bring about.the recovery of a paralysed l»ortion of intestine by means of enterostomy, the fistula must be placed above the paralysed part of the intestine. 5. As in many cases the paralysis also includes the u])permost portion of the jejunum, and probably also the duodenum below the papilla of Yater, there is in these cases no other way than to make a fistula (gastrostomy) in the pyloric portion of the stomach. 0. If at an operation I have emptied the contents of the small intestine, and in spite of this the jejunum shows no signs of contraction, I at once perform gastrostomy. 7. If, in a case where no indication for primary gastrostomy is found, the size of the abdomen increases, the frequency of the pulse rises or remains high, and two or three irrigations of the 1 XorcL Tidslcr. f. Tcrapi, Kjobenliavn, 1905, May.