Appendicitis : its pathology and surgery / by Charles Barrett Lockwood.

  • Lockwood, Charles Barrett, -1914.
Date:
1906
Catalogue details

Licence: In copyright

Credit: Appendicitis : its pathology and surgery / by Charles Barrett Lockwood. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

    283/308 page 267
    already said, the ileocecal valve and the vermiform appendix are supplied by the same artery—the posterior ileo-caeca] so that they have a close vascular relationship to one another. Operation may be undertaken for appendicitis, complicated with localised or generalised septic peritonitis. These are generally cut short by the removal of their cause, which may be an ulcerated and infected appendix, or one which is perfor- ated or gangrenous, or both. Unfortunately the opposite may occur, and the septic peritonitis may receive an impetus and be made worse by the operation. Septic peritonitis, whatever its extent, is almost sure to hinder the propulsive action of the intestinal muscle, and is, therefore, nearly always accompanied with flatulent distension, and, in its later stages, with intestinal obstruction. Ex- ceptional cases occur in which diarrhoea is met with, but in my experience they are unusual. Flatulent disteusion is also permitted by the state of the abdominal walls, and it is favoured by weakness and relaxation of the abdominal muscles. It is common in women with thin, flaccid, weak abdominal muscles. The injury done to the abdominal walls by the operation, is another cause of flatulent distension. The bruising and laceration of the muscles render their action painful, and they cease to exert their wonted pressure upon the intestines. The presence of sutures has, at first, a similar effect, so that the expulsion of flatus by the abdominal muscles is, for a time, in abeyance. In simple cases, the flatulence usually begins about eighteen or twenty-four hours after the operation, and is over within the next twenty-four. In some cases, relief is given by simply passing the rectal tube and leaving it in the rectum for half an hour at a lime. The patient may, at the same time, be turned upon the right side. Should this fail, an enema of soap and water with half an ounce of castor oil and half an ounce of turpentine, usually succeeds. In addition, the enema of assafcetida of the British Pharmacopoeia or the old- fashioned rue enema may be tried. These remedies seem very harmless. They may make the anus and rectum sore, or excite vomiting, or accelerate the heart tor a little time. But should
    digitised image 1
    digitised image 2
    digitised image 3