On malformations of the hind end of the body.

Date:
[1908?]
Catalogue details

Licence: In copyright

Credit: On malformations of the hind end of the body. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    15/40 (page 15)
    Results of Operation. I do not propose to deal with the operative procedures to be adopted for the treatment of malformation of the rectum, but a study of these specimens has forced several matters on my attention. One is the great danger of using a trocar for the relief of the condition; there are eleven preparations mounted purposely to show perforations into the pouch of Douglas or a separation of the coats of the rectum by the use of the trocar; Curling and Harrison Cripps have emphasized the danger of the trocar. There should be no half measures in operating ; in 95 per cent, of cases it is physically possible to bring the rectum down to the perineum; if it be not found terminating at the site of the proctodaeum, it will be found perforating the pro- state or the lower end of the vagina; if not there, then at the base of the prostate or upper part of the vagina. If un- relieved, death occurs about the fifth day from gangrene and rupture, usually towards the upper part of the colon. The prognosis is bad; an imperforate condition of the rectum appears to react on the economy of the child even before birth, and death commonly ensues, even if the rectum be opened early. The prognosis is favourable in the case of females where the rectum opens in the vulva ; in all cases hypertrophy and dilatation of the rectum follows, even if an anus is successfully established. It is important to remember that the external sphincter and also internal sphincter are developed in connexion with the perineum, not with the bowel; hence, if a proctodaeum be present, the surgeon may rely on obtaining an orifice provided with competent sphincters. [Besides the authorities cited below, the following works may be consulted with advantage : Ballantyne’s Antenatal Pathology; Dr. William Wright’s Report on Recent Terato- logical Literature, published annually in the Journal of Anatomy and Physiology ; The Rectum and Anns, by Sir Charles Ball.] References. IT. B. CuiTing, Observations on the Diseases of the Jtectum and Anus, London, 1876. ‘^W. Hairison Cripps, The Diseases of the Rectum and Anus. London, 1907. * F. Wood Jones, British Medicai. Jouunai., 1904, vol. ii, 7). 1630. F. P. Mall, Journ. of Moriih., vol. xix, 1908, ii. 3. ®D. Berry Hart, Journ. Anat. and Physiol., vol. xxxv, 1903, i). 330. ®H. von Bardeleben, Archivfiir Gynaekoloyie, Bd. 68, 1903, ]>. 1. l P. S. Mackenzie, Jbitj'n. Anat. o/itl P/iiysioJ., vol. xl, 1906, i). 409. ^A. Stieda, Langenbecl-'s Archiv fUr klin. Chiruroie, Bd. 70, 1903, p. 555. 8 jjate. Lancet, December 24th, 1904. lo S. W. Kelly, Journ. Amer. Med. Assoc, vol. ,xlix, 1907, p. 1979.