Intestinal obstruction : its varieties with their pathology, diagnosis, and treatment.

  • Treves, Frederick, 1853-1923.
Date:
1904
Catalogue details

Licence: Public Domain Mark

Credit: Intestinal obstruction : its varieties with their pathology, diagnosis, and treatment. 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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    was passed on the twenty-second da}^ The patient was walk- ing out of doors at the end of the fourth week. In March, 1897, he had regained his ori^nal weioht, and his bowels were acting well with aperients. I then performed a second laparotomy to remove the sigmoid flexure. Although onW thirty-eight days had elapsed since the passing of the button I found the artificial opening I had made so contracted that it would do no more than admit my little finger. I removed the whole sigmoid flexure and united the descending colon to the rectum by means of the same button. This button was passed on the sixteenth day. The patient recovered rapidly and remains in sound and vigorous health. The explanation of these cases of contraction, whether in the stomach or in the colon, is not far to seek. The button effects an o]3ening between the two viscera by means of pressure gangrene. I have noticed that after-contraction has only occurred in cases in which the upper viscus was much dilated at the time of the operation. It is needless to say that in gastro-enterostomy for pyloric obstruction a dilated stomach is met with, and in intestinal anastomosis for stricture the upper segment of the gut is apt to be enormously dis- tended. After the operation the dilated organ contracts and consequently the newly-made hole contracts. I can easily imagine that a hole in a dilated stomach made by pressure gangrene and of the size of half a crown ma}^ readily become an aperture of the size of a fourpenny-piece when the dis- tended viscus has gradually contracted. It is, therefore, very desirable to have the viscera to be dealt with as empty as possible before the button is introduced. This end is very difficult to secure even in a partial degree. The stomach, for example, in old pyloric obstruction, even when kept washed out for many days, is slow to contract, and if at the time of the operation the viscus be still much dilated, retention of the button and some inconvenient contraction of the new opening may be regarded as possible. This association be- tween previous distension of a viscus and the subsequent contraction of the aperture made in it is, of course, by no means limited to Murphy's button. It applies to nearly every method in vogue for carrying out the operations now under discussion. In employing Murphy's button in the colon, it is desirable that the passage below the point of insertion should be clear. Thus, in one case in Avhich I short-circuited the colon for malignant disease there was a stricture of the rectum near the anus, due to an extensive operation for fistula. This pre- sented a serious obstacle to the final removal of the button.