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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    0.3 O.Z out at 10 A.Ji., and a large quautitj'^ of thin, badly smelling, brownish Iluid evacuated. At 12 o’clock noon the stomach was again washed out, and a smaller quantity of the same kind of fluid brought up. At the washing done at 7 p.m. the contents were of a yellowish colour. At 4 P.M. the patient was given an enema, whereby much wind and thick coloured intestinal contents escaped per rectum. .Simultaneously he Avas given subcutaneously 1000 c.c. saline solution Avith i5 per cent, grape sugar and 15 drops digitalis. The temperature in the morning of 11th January Avas 40°'2, at noon 40°'4, and in the evening 40°; the pulse at the same periods being 140, 140, and 132. The urine contained traces of albumin, and gave Rosen- bach’s reaction for indol and skatol. The quantity of urine ijassed during the twenty-four hours Avas 1150 c.c. By the evening of the. 11th it Avas evident that both the large and small intestines had recovered their function, Avith the exception of the duodenum and, in all probability, the jejunum above the upper fistula. At midnight on the 11th the patient Avas given subcutaneously 1 mgrm. physostigmine, Avhich ^immediately caused the boAvels to act. Much flatus and loose fmcal matter Avere passed per rectum. During the 12th the patient received tAvo intravenous infusions of 1500 c.c. saline solution Avith y ])er cent, grape sugar and 8 drops adrejialine (1 to 1000), the one at 1.26 A.ji. and the other at 1.28 p.m. During the night of the 11th and 12th, and up to the second operation at noon on the 12th, the stomach Avas Avashed every three hours, whereby badly smelling gastric contents of a deep yelloAvish colour came aAvay. At 2 a.m. the intestine Avas irrigated, Avhich caused highly coloured intestinal contents to escape. At 8 a.m. a tube Avas passed into the rectum, and a considerable quantity of gas and fluid intestinal contents got rid off; this Avas repeated at 11 a.m. and at 2 p.ai. When, in spite of frequent Avashings, the contents of the stomach Avere feculent in odour, one concluded that there Avas ])aresis or kinking of the upper part of the jejunum, and consequently at 2 p.ji. a (/asiroH- toiny teas made. Local aniBsthesia AA'as effected by the apiilication of anestile to the skin and aponeurosis in the linea alba, and a ^ per cent, solution of cocaine Avith adrenaline Avas injected into the subserous tissue. A AVitzel’s fistula Avas placed in the pyloric portion of the stomach near the large curvature; the tube Avas of 5 mm. diameter. Directions Avere given that irrigations Avith^per cent, hydrochloric acid solution Avere to be made through this tube. The fluid Avhich escaped Avas to be collected in a bottle; and as soon as it had no perceptible smell, it Avas to be injected through the upper of the tAvo fistulse in the small intestine, together Avith some ]\Iellins’ food, beaten egg, and bicarbonate of soda. The general condition of the patient was satisfactory during the day. He did not complain of pain. The urine shoAved only a trace of albumin. The temperature Avas taken four times: in the morning 39°'5, in the forenoon 39°‘3, at noon 39°'6, and in the eA^ening 39°‘6. The pulse at the same periods Avas : 140, 120, 148, 128. January 13.—The patient having had no sleep, tAvo tablespoonfuls of a solution of bromide of potassium were given a little before 3 a.ji. through the loAver fistula in the small intestine. A considerable quantity