The Hunterian lectures on the pathology and surgery of intussusception : delivered at the Royal College of Surgeons of England / by D'Arcy Power.

Power, D'Arcy, 1855-1941.

Date:: 1897

Credit: The Hunterian lectures on the pathology and surgery of intussusception : delivered at the Royal College of Surgeons of England / by D'Arcy Power. 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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$abdomen at once in every case where this condition is sus- pected. The method of irrigation under hydrostatic pressure is the most satisfactory way of distending the colon in cases of colo- colic and ileo-cascal intussusception. The fluid is allowed to pass into the large intestine by its own weight, so that the force can be accurately estimated by observing the height to which the reservoir is raised above the recumbent body of the patient. The valuable experiments of Mr. Mortimer7 in London and of Mr. Mole8 in Bristol have greatly increased our scientific knowledge of the effects of irrigation in the treat- ment of intussusception. They have shown that the results depend partly upon the obstruction to be overcome within the intestine and partly upon the external support. The greater the pressure within the abdomen the more is the dis- tending force neutralised, for the intestinal wall is then com- pressed between two opposing forces. Mr. Mortimer experi- menting upon the unopened bodies of children, points out that in an irreducible intussusception the large intestine is distended by almost the whole force of the stream when the abdominal walls are lax, as iB usual in children under chloroform, and when there is not much tympanites. The intestine may kink if fluid be allowed to enter the bowel too suddenly or too forcibly, and the distending force is then prevented from acting upon the intussusception, so that the colon may become sufficiently overdistended to rupture. A similar accident may happen as a result of a sudden peristaltic contraction taking place whilst the pres- sure is being applied. There is apt to be cracking of the serous coat of the large intestine when the resultant pres- sure of the fluid distending the colon is about 2\ lbs.—that is to say, when the irrigator is raised 5 feet above the body of the patient, and this accident usually happens when the irrigator is raised to 8 feet, though the bowel may be com- pletely ruptured when the reservoir is only raised to a height of 6 feet. Mr. Mole used a slightly different method of experiment, but he arrived at substantially the same results, and, as he worked with the abdomen open, he was able to see the exact manner in which the intestine ruptured as a result of its overdistension. When this accident is imminent the peri- toneal coat of the bowel splits longitudinally for a consider- able length ; the fluid then begins to leak through the wall of the gut, a small jet issues, and at last, if the pressure be continued, a large rent takes place, with forcible expulsion of the contents of the bowel into the peritoneal cavity. Rupture of the large intestine is most likely to occur in the transverse colon; at or near to the splenic flexure, whilst in the small intestine it takes place in the unprotected portion of the bowel which is situated between the two layers of tho mesentery. It should be borne in mind, however, that these results are derived from experiments upon dead bodies and upon animals. It is impossible for the surgeon to estimate the capacity of the colon in any individual case of intussuscep- tion, nor can he judge the amount of pressure that may be applied with safety to the inflamed and softened intestinal wall at the neck of the tumour. A pint of fluid was sufficient to rupture the bowel in a child, aged 3 months, though the injection was made by one of the most careful and experi-$