A case of sarcoma of the small intestine : with a note on the significance of 'rebound pain' in certain abdominal inflammatory conditions / by J.M. Elder.

  • Elder, John Munro, 1859-
Date:
1904
Catalogue details

Licence: In copyright

Credit: A case of sarcoma of the small intestine : with a note on the significance of 'rebound pain' in certain abdominal inflammatory conditions / by J.M. Elder. 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.

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    In examining the abdomen of a patient suffering from acute abdom- inal symptoms, palpation often determines, better than anything else, the acuteness of the process and the urgency of the case. In such a case one is often able to press quite deeply into the abdomen without causing much pain. This must be done gently at first and the pressure gradually increased, and is done most easily in the quadrants not the immediate site of the disease; and these should be first examined, to accustom the patient to the process. If this is done, and the pressure suddenly relieved by quickly remov- ing the hand, the abdominal wall will rebound, and the amount of pain produced is the measure of the degree to which the sign is present. The explanation of the pain and of its significance seems to be as follows:— It is taken as indicating the presence of tension in an inflamed viscus, those most often concerned being the appendix and Fallopian tubes. By pressure on the abdomen the contents are crowded laterally, and the intra-abdominal pressure around the inflamed viscus raised. When done gradually, this may cause relatively little pain. When the hand is quickly withdrawn, however, there is a sudden lessening of pressure outside the viscus (appendix or tube) and, if the fluid within be under tension, there is a definite shock to the wall as the pressure change is compensated. This causes sharp, sudden pain, which is intensified by its un- expected character, and the patient generally gives an involuntary start or cry, at times almost bounding from the bed. It is, perhaps, a sign most valuable iu appendicitis, where the question of when to operate and when to wait is so important. If it be present, there is tension and danger of perforation, but per- foration has not yet occurred. This warning is especially valuable in cases of the gangrenous type, where the constitutional disturbance may be comparatively slight, but the rapidity with which perforation may occur is unusuallv great. On the other hand, it is absent where perforation has already taken place and tension has been thus relieved In such cases there is generally a history suggesting perforation and the absence of this sign is useful only as confirmatory evidence. A marked instance of its value occurred in a case under my care during the past summer. Patient was a young man who had been ill for one day only. He gave no history of former attacks. Temperature and pulse normal.
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