Diseases of the rectum and anus / by Alfred Cooper and F. Swinford Edwards.

  • Cooper, Alfred, Sir, 1846-1908.
Date:
1892
Catalogue details

Licence: Public Domain Mark

Credit: Diseases of the rectum and anus / by Alfred Cooper and F. Swinford Edwards. Source: Wellcome Collection.

    268/388 (page 232)
    prolapsed of lute, and the quantity of blood lost has been only slight. Jfo slimy discharge fi'om the bowel; bladder very irritable at night; has lost about two stone in weight since the symptoms became ui'gcnt. Thoracic organs and urine normal. Three days tifter admission, the patient being under ether, Mr. Cooper, assisted by llr. Edwards, performed inguinal colotomy on the left side, the incision being two inches in length. The small intestine first pre- sented ; the sigmoid was found lying diagonally across the abdomen, just underneath the umbilicus. A loop was drawn out, and a deep suture was passed thi'ough the mesentery and lower lip of the wound. Four silk sutures were passed between the bowel and the parietal peritoneum. The operation occupied forty minutes. The patient went on well until the following evening, when a rigor came on. On examining the wound, the bowel was found to have receded considerably. It was therefore decided to place the patient under chloroform. On removal of the di'essings, a portion of the small intestine was found prolapsed through the wound, the colon having slipped back and torn through the stitches. The small intestine was cleansed and replaced, and the abdominal cavity was washed out with a warm boracic solution (gr. xx. to 3]'.). The colon was then picked up and refastened to the skin. Sick- ness came on dming the night and another rigor on the following morning, and the patient gxadually sank and died in the evening. At the autopsy no signs of peritonitis were discovered; death was presumably due to shock. Case 19.—A. B., aged thii-ty-three, married woman; one child living, four dead, and two miscarriages; admitted into St. Mark's Hospital, February 28, 1891. The symptoms began eight years ago with loss of blood from rectum at stool, the patient being then pregnant for the second time. Two years afterwards defajcation became difficult, and other symptoms of rectal stricture were gradually manifested. For their relief Mr. Edwards performed linear proctotomy, the results of which were for some time satis- factory. An offensive yellow discharge, however, has continued to escape fi-om the rectum, and for the last eighteen months there has been increasing difficulty in deffecation, with occasional loss of blood, vomiting, and loss of flesh. March 3. Mr. Edwards, assisted by Mr. Cooper, performed left inguinal colotomy, making the usual incision, and using a flat sponge to repress the intestine. The parietal peritoneum was attached to the skin with silk sutures, and a loop of bowel was readily hooked up and the deep suture passed as already described. The bowel was then secured to tlic skin by three or four silk sutures passed thi-ough the peritoneal and muscular coats. Sickness was troublesome for two days after the operation,