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.

    15/16 (page 31)
    stomach show retention of foul-smelling or stagnant fluid, then there should be no delay in performing gastrostomy. We have acted on these principles during the last six months, and in vidw of the results obtained, and which I hope soon to have an opportunity of publishing, I look a little more hopefully on ])aralysis of the intestine than I did last year. In a previous article ^ I insisted upon the necessity of the patient being sub- jected to operation before paralysis oLthe intestine has developed. Should this prove impossible, we hatftto provide for the emptying of the intestine by making one or more enterostomies, as was done in the present case. Although the life of the patient may be saved by the making of fistulte in the small intestine, all surgeons will agree that they are better avoided, if possible. I am now of the opinion that cases of considerable paresis or paralysis of the intestine may be restored to health by emptying the intestine at the time of opera- tion by enterotomy or colotomy, and reserving typhlostomy or gastrostomy, or both, as may be called for in special cases. Xo organs are more snitalde for an oblique fistula, made after the method of Witzel, than the ctecum and the stomach. Tlie pyloric portion ought to be chosen, as, according to the investiga- tions by Cannon, the fundus empties itself into the pyloric portion, and this latter through the pylorus into the duodenum. The pyloric portion empties itself into a fistula only when the passage through the pylorus is no longer available. This agrees with onr experience. As soon as the passage through the small intestine is free (the paralysis of the small intestine having been recovered from), nothing escapes through the gastric fistula, if the patient is not allowed to consume a great quantity of fluid at one time. If an oblique fistula has lieen made in the Ccecum or stomach with a tube of 5 mm. diameter, and the operation has been undertaken at a period of the illness when the walls of these viscera are still relatively healthy, it may always be reckoned upon that the fistula will close as soon as the tube is withdrawn. The suggestion to deal with the paralysis of the intestine which complicates peritonitis by means of gastrostomy is not new; but, as far as I know, only one case has been published—by Jaboulay -—which has been thus treated. F. Lcjahrs mentioned it in his introductory paper on acute peritonitis at the International Surgical Congress at Bruxelles, 1905. After having described eii- terostomy, Lejahrs says: “ Let us, lastly, note a case of gastrostomy, made by Jaboulay in order to counteract a severe degree of distension of the stomach, and which greatly relieved respiration and at last restored health. This is a very interesting experiment, which is to be remembered and repeated in those cases where irrigation of the stomach cannot be done or does not suffice.” ^ Lor. cU. = Jaboulay, Lyon med., 1905, Marnli 12, p. 560.