Rectal stricture of puerperal origin, relieved by laparotomy / by N. Stone Scott.

  • Scott, N. Stone.
Date:
1893
Catalogue details

Licence: Public Domain Mark

Credit: Rectal stricture of puerperal origin, relieved by laparotomy / by N. Stone Scott. 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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    Of linear proctotomy “'I'he American Text l5ook (jf Surgery says : “It cannot be ])ractised wlien tlie stiicture is liig’h up or of i>'reat extent; here \ve must perform colotomy to save tlie patient’s life.” The four cases formincr the basis of this paper were from three to seven and a half inches from the anus, and it is not im- probable that most false strictures are hi oh u]>, situated above the floor of “Douglas's pouch.” Any operation tbrough the rectum must not only cut through sound tissues, exposing them to the dangers of infection, but, if the o])eration is thorough enough to divide tlie constricting band, must also open the peritoneal cavity, which is the danger to be feared in linear proctotomy. Colotomy is rightly a last resort; and, if a case judged to be a false stricture proves, on opening the abdomen, not to be di- rectly amenable to surgical treatment, a colotomy can be performed, and the median abdominal incision closed, without materially adding to the dangers of the colotomy. I have endeavored to show that there are cases of stricture where the pathological condition is situated outside of the rectum. These I have denominated false stricture in contradistinction to true stricture. False stricture is usually the result of an inflammation start- ing without the rectum. The puerperal condition is an important etiological factor. Presents the same clinical ])icture as the true stricture. Situated above the floor of “Douglas’s pouch.” 1 heoretically false stricture can be best treated by lapar- otomy.