Landmarks, medical and surgical / by Luther Holden.

  • Luther Holden
Date:
1877
Catalogue details

Licence: Public Domain Mark

Credit: Landmarks, medical and surgical / by Luther Holden. Source: Wellcome Collection.

    50/116 (page 38)
    Large in- testine. Colotomy. reasons I believe that, although we can easily ascertain its degree of tenderness on pressure, we cannot actually feel it unless it be considerably enlarged. We must be on our guard not to mistake for the kidney an enlarged liver or spleen or an accumulation of faeces in the lumbar part of the colon. 84. Let us now trace the large intestine and see where it is accessible to pressure. The ' caecum,' or ' caput coli,' and the ileo-caecal valve lie in the right iliac fossa. The ascending colon runs up the right lumbar region over the right kidney. The transverse colon crosses the abdomen three or four inches above the umbilicus. The descending colon lies in the left lumbar region in front of the left kidney. The sigmoid flexure occupies the left iliac fossa. Throughout the whole of this tortuous course, except at the angles of the transverse colon, the large bowel is access- ible to pressure, and we could, under favourable circum- stances, detect hardened faeces in it. Within the last few months we have had two instances of this in St. Bartholo- mew's Hospital. One was a collection of faeces in the transverse colon, which formed a distinct tumour in the abdomen. All the symptoms yielded to large and repeated injections of olive oil. The other case was an accumulation of faecal matter in the sigmoid flexure, which during life was thought to be malignant disease. 85. The operation of opening the colon (colotomy) may be done in the right or left loin, below the kidney, in that part of the colon not covered by peritoneum. The landmarks of the operation are :—(i) The last rib, of which feel the sloping edge; (2) the crest of the ilium ; (3) the outer border of the ' erector spinae.' The incision should be about three inches long, midway between the rib and the ilium. It should begin at the outer border of the ' erector spinae,' and run not quite transversely, but rather slope in the line of the rib. The edge of the ' quadratus lumborum,' which is the guide to the colon, is about one inch external to the edge of the * erector spinae/ or three full inches from the lumbar spines.