Some congenital malformations of the intestinal canal / by William Turner.

  • William Turner
Date:
[1863]
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Licence: Public Domain Mark

Credit: Some congenital malformations of the intestinal canal / by William Turner. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    by wliicli tlie shrivelling up iDoth of the ductus arteriosus and right aortic root is occasioned. Connected with tlie canal of the intestine are certain appendicular embryonic structures which, in the ordinary course of development of the entire body, disappear. The vitelline duct is one of these structures. It is continuous with that part of the intestinal canal whicli subsequently becomes the ileum, its connexion with this portion of the bowel being indicated, even in some adults, by the occasional presence of a diverticulum. More commonly, however, it shrivels up and disappears. Now, it is quite possible to conceive that the atrophy may not be confined to the vitelline duct, but may be extended to the intestine at the spot to which the duct is con- nected. And thus the canal may become closed, or its further growth beyond the stage which it possessed when the atrophy of the duct commenced either retarded or altogether prevented. Cases of intestinal obstruction have been recorded which appear to bear out this supposition; cases in which the obstruction had arisen fi-om diminution in the size of the gut, without any evidence of inflammatory mischief. Such, in particular, seems to be the explanation one might give of the origin of an obstruction in the first of two cases recorded by Dr Carver.^ An infant which died on the fourth day after birth had contraction of the ileum, beginning about 12 inches from its coecal end, i.e., at the place where with reason one might suppose the vitelline duct had been attached. And it is particularly noted in this case that there were no signs of inflammation either of the peritoneum or bowels. In a second case, an infant which died on the sixth day, there was a similar con- dition of the ileum, but it was complicated with acute peritonitis, ulceration, and perforation of the lower part of the ileum and coecum. It appears probable, however, that in this case the atrophy of the intestine preceded the peritonitis rather than that the atrophy was a result of the inflammation. But though disposed to look upon some cases of intestinal obstruction as occasioned by an extension to the bowel of the process of atrophy, which produces a shrivelling up of some of its embryonic appendicular structures, yet I do not think that the case now before us can be brought into the same category, for the jejunum has not at any period of its development a structure like the vitelline duct connected with its coats or continuous with its canal, serving merely an embryonic purpose and subsequently disappearing. I am inclined, therefore, to regard the inflammatory theory as the one to which the contraction and atrophy of the bowel ought in this case more probably to be referred. And that peritonitis is not unfrequently tlae cause of various malformations in the intestinal and other abdominal viscera has been satisfac- torily established by Professor Simpson, in his well-known memoir On the Inflammatory Origin of some Varieties of Hernia and J Britisli Medical Journal, lltli August 1800.