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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    he got 50 drops tinctura opii in five doses of 10 drops. The patient Avas admitted to the liospital on 10th January at 6.30 p.jf. On admission, the patient was found to he a strongly built man in good general condition. There was no nausea. The pains Avere slight, and were diffused over the Avhole abdomen. Temperature, 38°; pulse, 92. White blood corpu.scle.s, 7100, 7300, and 8100 per c.mm. at three different countings. Local symijtoms.—Dilfuse and well-marked distension of the abdo- men, with a tympanitic note everywhere except in the lumbar regions, where the note is somewhat dull. No resistance palpable. No peri- stalsis visible or palpable. There is great tenderness in the centre of the abdomen, over a nearly circular area with a diameter of 6 to 7 cms., and reaching about 1 cm. above the umbilicus. There is also tenderness, though less marked, from Poupart’s ligament on the right side upwards to near the costal margin, and from there obliquely downwards to the fore part of the left iliac crest, i.e. nearly over the whole region of the small intestine. Per rectum a bulging tender mass can be felt. The outer opening of the inguinal canal is free on both sides. The patient was operated on at 9 p.m., under ether, two and a half days after the commencement of the symptoms. The most likely diagnosis was volvulus of the small intestine, and it u^as considered possible that Meckel’s diverticulum was involved also. An inflamed MeclceVti diverticulum rcav found, adherent to the anterior abdominal wall near the umbilicus, and a twisting (at least through 360°) of nearly the xvholc small intestine. The constriction groove was found somewhat distal to the place of origin of the diverticulum, the proximal place of twisting was the duodeno-jejunal flexure. There was a diffuse licemorrhayic sero- purident peritonitis. Operation.—Extirpation of iMeckel’s diverticulum. Untwisting of the small intestine. A Witzel’s fistula was made in the jejunum 45 to 50 cms. from the duodeno-jejunal flexure; another in the ileum about 1 metre above the valve of Bauhin, and a third in the csecum, all three being provided with tubes of 3 mm. diameter. Account of the operation.—The incision was made in the middle line below the umbilicus; it was afterwards extended upwards, and the right I'ectus muscle Avas cut across. There was a heemorrhagic, turbid fluid free in the peritoneal cavity. The small intestine was enormously distended, and tended to protrude. In the extra-peritoneal layer of the abdominal Avail opposite the umbilicus there Avas a cavity the size of a medium-sized apple filled Avith fluid and gas; this Avas traced into a portion of small intestine Avhich proved to be a Meckel’s diverticulum. This originated from the ileum about ^ of a metre above the valve of Bauhin. The ileum Avas red, and beyond the diA-erticulum it Avas distended to a girth of about 10 cms. The mesentery of the distended intestine was twisted at least 360° in an ojAposite direction to the hands of a watch laid upon the umbilicus Avith the face upAvards. The diverticulum Avas dissected free from the anterior abdominal aaMI, and resected near the ileum. The undoing of the volvulus Avas folloAved by the escape of all the distended coils outside the abdominal cavity AA^herc they could no longer be lodged. They Avere Avashed Avith saline solution and covered Avith gauze Avrung out of saline solution, over Avhich Avas
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