Intestinal obstruction; its varieties : with their pathology, diagnosis, and treatment.
- Sir Frederick Treves, 1st Baronet
- Date:
- 1899
Licence: Public Domain Mark
Credit: Intestinal obstruction; its varieties : with their pathology, diagnosis, and treatment. 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.
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![a spot corresponding to the usual origin of Meckel's diverti- culum. [This subject is dealt with in chapter VIII.] There is every reason to believe that these congenital strictures are due to excessive changes incident upon the obliteration of the vitelline duct. In all the examples of complete stricture there has been no trace of the duct. It is probable that in the cases now imder consideration the stenosis is con- genital, and due to irregular developmental changes. I Avas at one time of opinion that the strictures found in these cases might be acquired, and due to the effects of continued traction upon the gut. I was struck with the fact that the diverticulum in nearly all the instances of associated stricture was adherent. It can be understood that traction upon the bowel would be apt to lead to bend- ing of it, to the production of occasional obstruction, and at least to interference with regular peristaltic movement. These conditions might well lead to ulceration of the bowel, and that to a cicatricial stricture. In the first of Dr. Sou they's cases, to which allusion has been made, the bowel Avas found to be ulcerated at the seat of the stricture. Too much weio-ht, however, cannot be attached to this fact, and in the examples I have been able to examine of stricture associated with a Meckel's diverticulum the narrowed part has shown no appearance of ulceration nor of cicatricial contraction. It is just possible that in a few instances the stenosis may be secondary to the adherent diverticulum, because I have met with instances in which a loop of small intestine held by an undoubted adhesion has been found to be narrowed at the point of attachment of the band. I have excluded from such instances those examples in w^hich both the stricture and the adhesion were evidently due to a primary ulcer of the intestine. Other Diverticula of the Intestine.—It will be con- venient here to deal Avith certain other diverticula which are met Avith in the boAvel, and Avhich, Avhen situated in the ileum, may possibly be mistaken for Meckel's process. These diverticula are of two kinds—(1) congenital and (2) ac- quired. 1. Congenital Diverticula.-—A pouch is occasionally found in the duodemivi. It is ahvays small, is placed in the second part of the intestine just above the biliary papilla, and is composed of the normal coats of the boAvel. The mouth of the pouch is Avide, and its depth is, as a rule, about one inch. There is every reason to believe that these iso- lated pouches Avhich are so constant in their position are de- pendent upon developmental defects or aberration associated](https://iiif.wellcomecollection.org/image/b21205516_0071.jp2/full/800%2C/0/default.jpg)
