Inversion of the appendix and caecum / by W.J. Greer.

  • Greer, W.J.
Date:
1909
Catalogue details

Licence: In copyright

Credit: Inversion of the appendix and caecum / by W.J. Greer. 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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    AND CAECUM. The number of recorded cases of partial or complete inversion of the appendix appears to be small, so the comparative uncommonness of the condition, as well as its interest, leads me to think that observations on an additional example are worthy of recital. History. A girl, aged 7, was admitted to the Newport and County Hospital under my care on February 29th, 1908, with a history of having had attacks of pain in the abdomen for five weeks previously. There was some diarrhoea at first, but lately the bowels had acted only in response to aperients. Blood had been passed by the rectum, and vomiting was frequent. Condition on Admission. The patient was obviously very seriously ill, the pulse small and rapid, the abdomen somewhat distended. Examination revealed a soft elongated tumour in the region of, and parallel to, the direction of the transverse colon; the tumour was freely movable, and manifestly tender to touch. A diagnosis of intus- susception was ventured, aud immediate coeliotomy determined on. A C.E. was administered by Hr. R. McC. Linnell, and Dr. O. K. Wright assisted at the operation. Operation. A vertical incision about 10 cm. long was made through the middle of the right rectus; the small intestine was found to be dilated and the caecum was not visible. The portion of the ascending colon in view was widely and tightly distended and fixed to the posterior abdominal wall. The appearances were very confusing, as three portions of small gut seemed to enter the base of the mass; on pulling gently on these one was seen to come away out of the centre of the mass, and proved to be a loop of small intestine which had merely packed itself into the hollow—most likely very recently, as it was not in any way strangulated. This disposed of two of the entering portions of small intestine ; the third was then defined as the termination of the ileum connected with an intussusceptum. Traction on this caused the tumour in the transverse colon to recede rapidly until about midway in the ascending colon, where it became immovable, and further reduction was impossible without serious tearing of the structures. A longitudinal incision was then made in the colon, the mass extracted, cut off at its neck, the disparity in the calibre of the tubes adjusted, fine silk sutures inserted, and the junction returned into the colon; a line of similar suture material was carried round the joint on the peritoneal aspect, the wound in the intussuscipiens united with a double row of sutures, a pint of hot saline poured into [637/09]