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.

    269/388 (page 233)
    imd on the sovonth there wiis nnicli pain in tlie abdomen; there had been several motions passed by the rectnm. On this day, Mr. Edwiu-ds opened the bowel; on the folloAving, ho excised the gut. During the next twenty-four hours the bowels acted twice freely through the inguinal opening; pain less ; motions very hard—had to be broken up ^\'ith spoon and fingers. On the eleventh the vomiting recurred, and continvied in spite of all measures adopted to check it. Towards evening symptoms of collapse supervened, and death occurred shortly before midnight. (^n post-mortem examination, the abdomen was found to be full of tiu-bid yellow fluid ; the omentum and coils of intestine were matted together. The colon contained large masses of faecal matter; the gut was finuly atlherent all round to the inguinal opening. There was no perforation in any part of the intestine. There was strictui'e of the rectum, and ulceration extending into the sigmoid flexui'e for about eight inches. The other organs of the abdomen and those of the thorax were normal. The cause of death was no doubt peritonitis, the sickness and inability to retain food con- sequent thereon producing exhaustion. It is worthy of note that the evidences of peritonitis were at some distance from the wound, and appeared to be of some standing and quite independent of it; in fact, it is almost certain that this woman was the subject of a localised peritonitis at the time the colotomy was undertaken. In addition to the fourteen cases referred to above, Mr. Edwards has had seven patients elsewhere upon whom he operated with success. At the West London Hospital he has had one fatal case, that of an infant a few days old, on whom inguinal colotomy was performed for imperforate rectum. In this in- stance again, death was due to a sudden prolapse of the small intestine through the wound. The bowel was returned, but fatal peritonitis supervened.* The fact that in each case (with the exception of No. 19) the fatal result was due to the same cause demonstrates the supreme importance of providing every possible support for the weak spot in the abdominal wall. If the mesentery is not suffi- ciently long to admit of the insertion of the deep suture, extra care must be taken both in fastenins: * See cluipter on Malformations, ]). 58.