The surgical treatment of wounds and obstruction of the intestines / by Edward Martin and H.A. Hare.

  • Edward Martin
Date:
1891
Catalogue details

Licence: Public Domain Mark

Credit: The surgical treatment of wounds and obstruction of the intestines / by Edward Martin and H.A. Hare. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    SUMMARY. 1. The congenital malformations which cause intestinal obstruc- tion are mainly due to prenatal inflammation, and may involve any portion of the intestinal canal, 2. Excepting atresia or imperforation of the anus dnd rectum, the common seats of this malformation are at or near the ileocsecal valve; in the duodenum, or at the juncture of the duodenum with the jejunum; in the sigmoid flexure of the colon. 3. In 28 per cent, of these cases the malformation is multi]:)le, and in over 10 per cent, is of such a nature (atrophy, extensive obstruction) that it is mechanically irremediable. 4. The symptoms are those common to obstruction (absolute con- stipation, fecal vomiting, pain, and tympany). If the trouble is in the colon, its seat can be located by gas or water injections; if near the pyloric valve, by the peculiar epigastric distention and the character of the vomit. The prognosis is absolutely bad, death usually taking place on the third day, though life may be prolonged for Aveeks. 5. The treatment is surgical. For imperforate anus, the coccyx may be excised, and the bowel sought for by cutting upward and backward. If this fails, or as a first resort where there is absence of bulging in the anal region when the child cries, the incision, as for left inguinal colotomy, should be made with digital exploration of the regions commonly malformed. If the conditions justify it, an attempt to form a new anus and rectum in the normal position, of these structures should be made, the finger from above being used as a guide. Finally, if this is not possible, and no other seat of narrowing has been found, the surgeon should resort to left inguinal colotomy. 6. Where the seat of obstruction is unknown, exploratory abdominal section is indicated, followed by either gastro-enteros- tomy, entero-enterostomy, entero-colostomy, enterostomy, or colos- tomy, as indicated by the special lesion and the condition of the patient. With chloroform as an anaesthetic, attention to the preser- vation of the body heat, and rapidity of manipulation in complet- ing the operation, fair results may be expected.