Case of strangulation of a loop of small intestine in the fossa intersigmoidea / by W. McAdam Eccles.

  • Eccles, William McAdam, 1867-1946.
Date:
[1896]
Catalogue details

Licence: Public Domain Mark

Credit: Case of strangulation of a loop of small intestine in the fossa intersigmoidea / by W. McAdam Eccles. 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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    The gangrenous piece of bowel, with the oedematous portion, was entirely excised, together with a V-shaped piece of mesen- tery. The contents of the upper dilated portion of small intestine were allowed to freely escape through the open end, and when fairly empty the rubber tube was drawn tight and secured at both places. The extremities of the healthy bowel were now united by Maunsell’s method. The loop being washed and returned, the peritoneal cavity was sponged out and the abdominal wound closed. The patient stood the operation, which lasted fifty minutes, very fairly well, and rallied afterwards. The vomiting and pain, however, recurred some six hours after the patient returned to the ward, and he died of exhaus- tion about twelve hours later. The post-mortem examination showed some general peritonitis, most marked in the region of the sigmoid flexure, which was itself thrown over to the right side of the body. There were no evidences of old peritonitis in the form of adhesions, all the inflammation present being of a recent nature. The sutures used in the anastomosis had held well, and there was but little distension of the gut above the resected portion. The unsuccessful termination of this case was not unlooked for, the occurrence of gangrene of the bowel being always of the very gravest import. The method used for the intestinal anastomosis is certainly one which is very efficient, and remark- ably easy and rapid in its accomplishment. This patient, like so many others, really perished for want of early surgical inter- ference when there were persistent signs of strangulation. The fossa intersigmoidea is formed in the meso-sigmoid, and has its aperture on the under surface, or, more strictly speaking, on the left side of this portion of the mesentery. This fossa was distinct in at least half of the subjects exa- mined in the Eooms during the years 1892-94, the exact per- centage being 53. This accords almost exactly with the re- searches of Mr. Treves, who gives 52 per cent, as his results. In the foetus the fossa is undeveloped. The Sigmoid artery passes obliquely down from the inferior mesenteric artery behind the peritoneum, then enters the meso-sigmoid, and there breaks up into several branches. In its course in the mesentery it makes a well-marked fold, which can usually be clearly seen even if no fossa be present. When the fossa is in existence the fold is accentuated. It seems probable that after birth the length of the omega loop increases, with a corresponding development of the meso-