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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    tion was performed, the operation sliowing that the symptoms were ilependcnt upon a perforative ])aralysis. We liave an unreported case where the abdomen was opened for internal strangulation Avheu a paretic condition of the bowel dependent upon enteritis was present. Many instances of failure to determine between these two conditions can be cited, and it is well known that the men of greatest experience express least confidence in making a differential diagnosis. The history of the case is always important. A previous attack of inflammation would suggest bauds or adhesions. A record of typhoid, or other ulceration of the bowel, would suggest stricture; a history of anomalies in the family would suggest a Meckle's diverticulum. An account of abdominal traumatism would suggest hernia through rents in the mesentery or omentum ; a history of stubborn constipation would suggest volvulus, impaction of feces, adhesion, or stricture. Age and sex must be considered—infants are prone to intussus- ception, young adults to internal strangulation, adult females' to fecal impactions. Males at about middle age or somewhat past it, to volvulus, this condition being exceedingly rare before the twenty- fifth year. Onset.—This will serve to distinguish the acute from the chronic forms of obstruction. If it occurs suddenly in a j^erson of good health, not presenting previous bowel symptoms, and especially if dependent upon some sudden or violent muscular exertion, the chances are greatly in favor of internal strangulation being the causative condition. Frequently, however, a violent outbreak with fulminant symptoms is found to depend upon a chronic form of obstruction. Pain and shock.—These symptoms are usually best marked in cases of internal strangulation. They both, however, depend in the beginning upon the amount of constriction to which the bowel is subject, and they may be, exceptionally, well marked from the first in volvulus or invagination. The seat of pain should be care- fully considered, since, if it is correctly referred to the position of the obstruction, and this is occasionally the case, it may be a valu- able diagnostic guide. 1 Treves, London Lancet, 1887.