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.

    5/16 (page 21)
    laid a tliiuk iiuliai’ubber sheet, and outside this again hot dry towels. After this two Witzel’s fistulas were made* in the small intestine, and by a process of “ milking,” the intestine was emptied through the tubes. The c£ecum and the ascending colon had a long mesenteiy, free from the posterior abdominal wall, i.e. the ascending and transverse meso- colon passed from the spine in direct continuation with the mesentery of the small intestine hanging down from the vertebral column. During the operation they had been twisted once. They were ])ut right, and the cfficum fixed to the abdominal wall by applying a Witzel’s fistula in the position of the anterior muscular band. After this the small intestine was examined right up to the duodenum. The bowel was .just as red as before, here and there were black spots (haemorrhages) of the size of a finger-nail. In the mesenterj also there were numerous htemorrhages. In the vicinity of the Meckel’s diverticulum the mesentery was folded by adhesions resulting from an old peritonitis. Xo signs of contraction could be seen in that i^art of the small intestine which had been twisted; even the jejunal part of the duodenum Avas Avidely dilated and paralysed. The portion of the boAvel in the Aucinity of the fistulce Avas fixed to the parietal peritoneum to the left of the abdominal incision by chromic catgut. On account of the distension of the small intestine the incision could not be closed, but the boAvels Avere covered Avith an indiarubber sheet, and outside this Avere seAvn com- pre.sses of sterilised gauze kept in place by means of sutures of metal or coarse silk ]>assed through the edges of the abdominal Avound. 'When the Meckel’s diverticulum Avas cut ojAen, it shoAved a finger- Avide piece of intestine, Avith SAVollen, red mucous membrane nearest the ileum. Suddenly this little intestine Avidened to a cyst of 6 to 7 cms. diameter containing purulent, feculent matter, and lined Avith a jAartly ulcerated mucous membrane. It Avas this cyst AA’hich had been found adherent behind the umbilicus. The pulse Avas at the beginning of the anmsthesia, 96. At the even- tration no change of the pulse Avas observed; it Avas good and remained beloAV 100 for nearly an hour, after Avhich it slowly increased to 112, and later on to 120. Then a dose of 20 egrms. camphor and 1 mgrm. strychnine Avas given subcutaneously, and intravenous infusion of saline solution Avas commenced. During the remainder of the operation the pulse improved and diminished in frequency, so that at the end it Avas 92 to 96, full and sti’ong. In all the patient got 3 litres 0'9 per cent, saline solution Avith 16 drops of adrenaline (1 to 1000) into his veins. The ciecal fistula Avas to be used for nourishing the patient. Through the fistulae in the small intestine the boAvel was to be irrigated Avitli saline solution. Through the lower one gases and coloured intestinal contents immediately began to escape, Avherefore the injections through this fistula Avere stopped. During the folloAving day and night about 4000 c.c. passed through this fistula. Through the upper one scarcely anything came. Fluid injected through this upper fistula did not come back. On account of the great quantity of fluid Avhich passed through the loAver fistnla, the pa.ssage betAveen the tAvo fistulae Avas con.sidered to be free, i.e. the greater part of the .small intestine had immediately regained its power of contraction. As the patient felt sick and had eructations in the morning of 11th January, the stomach Avas Avashed