The mode of death from acute intestinal strangulation and chronic intestinal obstruction / by Thomas Bryant.

  • Thomas Bryant
Date:
1885
Catalogue details

Licence: Public Domain Mark

Credit: The mode of death from acute intestinal strangulation and chronic intestinal obstruction / by Thomas Bryant. 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.

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    clirouic cases, such as in soverity seem to be parallel with cases of obstructed or incaroerated hernia, running on to strangulation, in- flation may bo justiliablo, and even successful; but tlien it must be employed in the early days of symptoms, that is, within the first three days ; later on, changes in the bowel are almost certain to have taken place, which would render the treatment by inflation or injec- tion fruitless, and probably dangerous. Under such circumstances, the treatment of intussusception by laparotomy seems not only expedient, but right; but it should be undertaken early, that is, on the formation of the diagnosis in acute cases, and in the more chronic on the failure of inflation employed within the first three days. When delay has taken place, and the probabilities of success following the operation of laparotomy are small. Nekton's operation of enterotomy seems to suggest itself, that is, the formation of an artificial anus above the seat of obstruction ; since by this operation relief is afforded to immediate symptoms, and time given for the pathological changes that follow sloughing and ulceration of the intussuscepted bowel to complete themselves in a satisfactory way. The treatment of an acute intussusception by opium alone is as delusive as is the treatment of an acutely strangulated hernia or in- testine by the same means; while the treatment of an intussusception by inflation is, as already explained, dangerous, although some- times successful. To support this view, the following cases may be recorded. Case xvi.—Harry M., a boy, seven months old, was admitted into Guy's Hospital on January 11th, 1880, with every symptom of intussusception, and the presence of a tumour in his left hypogastric region. The bowel was inflated, and it was thought the tumour had disappeared. The next day, however, the tumour was as large as ever, and an operation was entertained ; it was not, however, carried out, as, after the administration of chloroform, no tumour could be felt. The child died on the fifth day ; and after death three inches of the ileum, with the caecum, were found intussuscepted into the colon. The bowel between the intussuscepted portion and the sigmoid flexure, was partially ruptured in many places. The peritoneal covering was cracked and turned out, and in the sacculi the longitudinal muscular fibres were torn and the transverse separated. There was also general peritonitis. Case xvii. —Jleo-ccecal Intussusception; Inflation; Eupttire of the Per- itoneal Coat; Extravasation ; Peritonitis.—The next case was also in a male infant. Alfred A., aged six months, was admitted into Guy's Hospital on November 23rd, 1873. The patient had been suckled entirely up to November 22nd, when it was not so cheerful as usual. During that day he was sick, and was in pain during the night. On November 23rd blood was noticed on his napkin, but there was no straining at stool. The bowels had acted on the 22nd. On admission, the child looked very ill. A tumour could be felt in the abdomen, of the size of a pigeon's egg, just above and to the left of the navel. The napkin was blood-stained. At 4.30 p.m. oil was injected into the bowel, but was rejected at once by straining. Chloroform was then given,
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