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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    sigmoid, but not accompanied by a contemporaneous elongation of the sigmoid artery. A slight depression is thus produced by the meso-sigmoid being drawn up, and this may subsequently be developed into a well-formed fossa. As far as I have observed, subjects having a short meso-sigmoid—that is, one less than two inches from the parietes to the bowel—have but poorly marked intersigmoid fossae, and conversely those with a long mesentery to the flexure have deep fossae; but further observa- tions on this point would be interesting. The fossa itself is most commonly placed at the point where the mesentery of the omega loop lies over the division of the left common iliac artery, and therefore just internal to the left psoas magnus muscle. Frequently, if there be but little extra-peritoneal fat, the left ureter may be seen through the layer of peritoneum forming the floor of the pouch. The sigmoid artery usually lies above the fossa and to its right; if there be more than one sigmoid artery, as is not infrequently the case, the fossa is shallower than ordinary. The pouch, which, as it will be easily understood, varies very considerably in depth, being seldom more than one and a half inches long, has its direction downwards and towards the left. The margins of the orifice are very sharp, and form an oval or round aperture, admitting in the majority of cases the last phalanx of the forefinger. These margins are commonly devoid of any blood-vessels. In some much rarer instances the fossa is of considerably larger size, and it is probably always so in those cases in which strangulation of the bowel takes place within it. According to Mr. Treves, the fossa is not infrequently obli- terated by adhesions. The but rare occurrence of a prolapse of bowel into, and strangulation by the edges of the opening of the fossa, is, as has been pointed out by Waldyer,^ due to several reasons. Firstly, in the normal position of the sigmoid the mouth of the fossa is placed out of the way of the coils of small intestine, and it is only when the loop happens to be thrown over to the right that its opening tempts prolapse into it. Secondly, the fossa itself is only occasionally large enough to contain a knuckle of intestine. Thirdly, the margin of the aperture has a tendency to act as a valve, so closing the entrance. Strangulation in the fossa duodeno-jejunalis appears to be rather more frequent than in the intersigmoid fossa. ‘ Virchow’s Arohiv, Band lx. S. 66.