The practice of surgery / by James Gregory Mumford ... with 682 illustrations.

  • James Gregory Mumford
Date:
1910
Catalogue details

Licence: Public Domain Mark

Credit: The practice of surgery / by James Gregory Mumford ... with 682 illustrations. 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.

    80/1044 (page 76)
    INTERNAL HERNIA Internal, retroperitoneal, or intra-abdominal hernise occasionally are found causing obstruction and even strangulation. Clinicalh-, these hernise cannot be diffei'entiated from obstructions due to bands, and are rarely made out before operation. Such hernia? are found in the foramen of Winslow, in the retroduodenal fossse, the retrocecal fossae, and the intersigmoid fossa. As with other conditions causing obstruction, the treatment is by operation. IDIOPATHIC DILATATION OF THE COLON Idiopathic dilatation of the colon is rare. It gives rise to a train of puzzling symptoms, is a cause of so-called phantom tumor, and mns a chronic course.' Dilatation of the colon usualh' begins in childhood, and is marked by obstinate constipation, occasional distention low within the abdomen, and malnutrition. As time passes the distention becomes pronounced, often being present for months, at times diminishing or totally subsiding, to recur later. An ether examination in certain cases causes an abun- dant discharge of flatus and disappearance of the tumor. Treves ^ states that in young children (the conditions) are due to congenital defects in the terminal part of the bowel, that there is in these cases an actual mechanical obstruction, and that this dilatation of the bowel is not idiopathic. It is probable that such permanent obstruction is sometimes the cause of the dilatation. The treatment of these cases of dilatation must be palliative at first by washings out through the rectal tube and by saline purges. If the dilatation persists, however, and becomes grave, as is sometimes the case, an operation is demanded. In cases not too far advanced, opening the abdomen, draining off the contents of the sigmoid, and fixing it to the abdominal wall, in case of torsion, may suffice for a cure. Commonl}^ however, in the old persistent cases more radical measures are necessary, and the treatment must be by excision of the affected coil. This should be done in two steps. An artificial anus should be made above the distention, first, by drawing out the sound gut and performing colostomy, the gut being left fixed outside of the abdomen. Later, when convalescence is established and the patient's general con- dition is improved, the distended bowel must be excised and an anas- tomosis made between sound intestine and rectum, or the lower portion of the sigmoid. TUMORS OF THE INTESTINE By far the most im])ortant and serious obstructions to the intestines in advanced life are those obstructions due to tumors of the intestine 1 R. H. Fitz, The Relation of Idiopathic Dilatation of the Colon to Phantom Tumor, and the Appropriate Treatment of Suitable Case.s of These Affections by Resection of the Sigmoid Flexure, Amer. Jour. Med. Sci., August, 1899. 2 Lancet, 1898, i, 276.