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.

    62/186 (page 64)
    lumen. Thus the shriukiug of plastic lyuipli deposited upon the bowel surface during an acute inflammation; the cicatricial con- traction following ulceration, whether simple, tubercular, tvplioid, or syphilitic; the narrowing following the extrusion by sloughing of an intussusceptum; the gradual blocking caused by matting together of coils of the bowel by extensive adhesions, by the dragging upon }.\n appendix of by kinking in connection with adliesions; and'finally the encroachment upon the lumen of the bowel by new growths, all ])roduce the symptoms of chronic obstruction. In addition, any of the conditions considered under the head of acute obstruction may, if there is not immediate and complete occlusion of the bowel, pass into the chronic form of the disorder. In the case of stricture the bowel above the point of narrowing is commonly dilated and ulcerated. The amount of narrowing is not necessarily indicated by the severity of symptoms, since fre- quently deatli occurs with an opening so large that it is hard to imagine why the obstruction could not be relieved. The most characteristic symptoms of chronic obstruction are as follows : irregular attacks of colicky pain, increasing in frequency and appearing a few hours after eating. There is frequently vomit- ing, which may become fecal on the supervention of an acute attack, it is rarely copious. There is not often much meteorism, and peris- talsis can frequently be seen plainly through the abdominal wall; this is at times exceedingly well marked. If a new growth causes tlie narrowing, in addition to the above signs a tumor may be detected. Prognosis.—This must be very guarded. Many cases Avith stricture of the bowel, under careful dietetics, run for years without serious developments. The general tendency is, however, toward progressive narrowing. Treatment.—By careful dietetics and attention to producing regular alvine evacuation, preferably by enemata, operative treat- ment may often be indefinitely postponed. When symptoms are progressive, however, operative interference must be counselled, particularly before the onset of ou acute attack. Here the patient is in fairly good condition, the surgeon is fully