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
Catalogue details

Licence: Public Domain Mark

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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    2] this point, and found that in one case when the colon was overdistended the adhesions which had formed round an ar- tificial invagination made three days previously gave way with an audible sound, and the intussusception was com- pletely reduced; but the force required to overcome the ad- hesions ruptured the serous coat of the intestine in three different places, and the animal died on the following day with diffuse peritonitis. He was more successful in another experiment, for the intussusception was reduced without any injury to the walls of the bowel, and the animal survived the operation. Abundant haemorrhage would seem to contraindicate any attempt to reduce the intussusception by irrigation. Much extravasation of blood implies destruction of the muscularis mucosae, infiltration of the submucous tissue, oedema of the circular muscle, and consequently a swollen condition of the mucous and submucous layers, with paralysis of the muscular coat. The swollen tissues render reduction difficult, and if the intussusception be reduced the paralysis of the muscle allows recurrence to take place, and may thus lead to the loss of much valuable time. Absence of haemorrhage, on the other hand, associated with severe collapse, equally contraindicates the treatment of intussusception by irriga- tion, for it points to the early recurrence of gangrene. A great disadvantage attends the use of irrigation for the cure of intussusception apart from the danger of rupture, which has already been sufficiently disoussed. This disad- vantage is the liability to recurrence after reduction. Dr. F. H. Elliott11 has published the details of a case of recovery from intussusception in a child, aged 8 weeks, in whom recurrence took place twenty-four hours after the first reduction, five days after the second reduction, and thirteen days after the third reduction. Dr. Chaffey15 had a less satisfactory experi- ence, for an intussusception recurred on five separate occa- sions until the patient—a boy aged 3 years—died of exhaus- tion. When recurrence is a very marked feature in a case, it is better to open the abdomen at once rather than to trust to repeated irrigation of the bowel, for it appears18 that re- invagination can positively be prevented by shortening the mesentery at the point of invagination by folding it upon itself in a direction parallel to the bowel, and maintaining it in this position by a few catgut sutures. No absolute rule can be laid down, however, for a child is now under my care who apparently has been cured of an intussusception, though irrigation had to be done oh five separate occasions before the tendency to recurrence was overcome. There appear to be several reasons for this tendency to recurrence. The first and the least satisfactory is that the conditions which led to the original intussusception may persist. An intussusception would then recur after any method of treatment, but it is particularly likely to do so when the reduction has been brought about by distension of the large intestine. A rapid distension of the colon followed by its sudden emptying are exactly the conditions which lead to increased peristalsis of its active and as yet uninjured walls. All methods of treating intussusception by dilatation of the bowel are therefore open to the objection that they predispose to a fresh invagination of the congested, com- ressed, and partially paralysed portion of intestine which as just been released. A second objection to this method of
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