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.

    563/586 (page 549)
    In. another example the growth for which the short circuit was made extended into the pelvis, and, had the large-sized button been used, it would hardly have escaped. In this instance a bone bobbin was employed. In any case the bone bobbin is a useful appliance, and in the hands of many surgeons has proved t,o be of great value. Forms of Stenosis other than Stricture.—The varieties of obstruction of the colon which come under this heading are alluded to on page 408. The colon may be adherent and be bent upon itself, and fixed in the bent position by adhesions, or the gut may be actually compressed by a mass of adhesions which pass across its free surface. In such cases it may be possible to divide the adhesions and to set the bowel free. Care should be taken in carry- ing out this desirable operation to see that the colon is really set free, and it may be necessary by suturing the mesocolon or by other n'leasures to fix the intestine in such a position that the distortion cannot be repeated. In one case in which a considerable raw surface was left after the division of adhesions I covered the area with omentum which was already adherent in the vicinity. This omentum was secured in place by fine silk sutures. A perfectly free omentum should not be employed for such a purpose, and I am not sure that excised portions of omentum (omental grafts) are to be depended upon. If the adhesions in these cases cannot be satisfactorily dealt with, the alternatives will have to be considered of an excision of the involved part with inmiediate suture, on the one hand, or a short circuit on the other. The case must be very exceptional in which one or other of these two measures cannot be carried out. I am not aware of a recent instance of this form of obstruction in which a colotomy represented the only means of treatment. Obstruction of the colon by a neoplasm can be dealt with by a more or less obvious series of operations which will meet the various possibilities encountered. An innocent pedunculated tumour may be removed through an incision in the bowel wall, which incision is at once closed. If the pedicle be broad, the operation may involve the excision ot a part of the bowel wall, such excision being of necessity very lunited in extent owing to the possibility of a stricture resulting therefrom. In the case of large and sessile tumours excision of the portion of bowel in which the neo]ilasm is growing is indicated. Failing such excision, Qothing remains but a short-circuit operation or a colotomy.