Volume 1

Green's Encyclopedia and dictionary of medicine and surgery / edited by J. W. Ballantyne.

Date:
1906-1909
Catalogue details

Licence: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

Credit: Green's Encyclopedia and dictionary of medicine and surgery / edited by J. W. Ballantyne. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    coiu'se, most valuable in preventing a post- o])erative diffuse peritonitis. After operations on the abdomen, tlie condition known as pseudo- ileus may occur, in which the earliest com- mencement of peritonitis is shown by abdominal distension and perhaps vomiting associated with intestinal paralysis. In this stage the adminis- tration of saline cathartics every hour imtil the bowels act, may avert the threatened attack of peritonitis by clearing the intestines of noxious material and aiding peritoneal absorp- tion. Turpentine enemata are also very valuable at this early period. When once the disease is fully established, purgatives can only be productive of harm, and such cases should be treated by cojliotomy as early as possible, after the diagnosis is made. In diffuse peritonitis following penetrating- wounds, or rupture of the viscera with extrava- sation of their contents, and occurring either after operation for these injuries, or during the expectant treatment of doubtful cases—ca'lio- tomy should at once be jjerformed, unless the condition of the patient forbids it. So, too, in diffuse peritonitis after evidences of intra-peri- toneal haemorrhage coeliotomy is indicated. By operation alone can we hope to remove accumu- lations of blood, pus, or other material in which the virulent germs are developing. After the abdomen has been opened, the coils of intestine should be separated, and any blood, pus, ficces, etc., removed by sponging or by irrigation. Any visceral lesion that is dis- coverable should be treated, if possible, in the manner alread}^ described. The various spaces which have been emptied of blood, pus, or other foreign material should then be lightly plugged with pieces of antisejatic gauze, the ends of which are brought out at one angle of the ab- dominal wound. The rest of the parietal wound —which is usually best placed in the mid-line— may then be closed in the ordinary way. Such measures may suffice for cases opei'ated upon in the early stage, though the mortality in all cases of diffuse peritonitis is very high. I]ven at a later stage, where the whole peritoneal cavity is severely inflamed, the disease is not absolutely hopeless, and Fiimey has proposed a more radical and remarkably successful method of treatment in these distressing cases—a method founded upon the belief that the great absorptive power of the peritoneum is much impaired by the presence of the large amount of plastic exudate which covers the peritoneum in diffuse peritonitis. An incision, long enough to admit of easy access to all parts of the peritoneal cavity, is made over the part from which the peritonitis is supposed to spring. The intestines are turned out into warm towels. The abdominal cavity is then mopped thoroughly clean by pledgets of gauze wrung out in hot normal saline solution, especial care being given to the pelvis. The intestines are then similarly wiped over systematically from end to end, so as to free them from all flakes of lymph. This procedure may require considerable force, and is aided by a stream of normal saline solution. The bowels are then returned into the abdominal cavity, the most affected portions being returned last, so that it may be better drained by gauze which is packed round it. The abdominal woiuid is then closed except at the point of emergence of the gauze. In the rapidly fatal cases, which apparently die from acute septic poisoning with few post- mortem evidences of the usual appearances of peritonitis, no treatment is very likel}^ to be effective. After coeliotomy the treatment of cases of diffuse peritonitis is conducted in the same manner as after operation for jjenetrating wounds of the abdomen. BuKN.s AND Scalds Burns and scalds of the abdomen are described under article Burns and Scalds. Abdomen, Pendulous. See Preo NANCY, Affections ov Uknehative Organs. Abdominal Abscess.—An abdomi nal abscess may occur in t/ie abdominal jxiftetes, i)i the peritoneal cavitt/, in, the various viscera or behind the 2'>eritoneum: Tliis article will be limited to a consideration of Abscess in the abdominal parietes, and Retro- peritoneal abscess. Abscess in the Abdominal Parietes General Considerations.— Suppuration in this situation may result from blows or wounds of the abdomen, rupture of muscle, or extravasa- tion of blood ; after acute specific fevers, and in debilitated conditions generally. In other cases it is secondary to abscess in the abdominal viscera, peritoneum, thorax, or adjacent bones. Most of the abscesses connected with bone disease are of a tubercular nature ; but primary tubercular abscess of the parietes, especially between tlie muscles, may also occur. Parietal abscesses may be situated superficial to, between, or beneath the muscles. In consequence of the loose connective tissue between the muscles, there is always a tendency for abscesses in this region to burrow extensively, though they are ultimately limited by the various muscular attachments. One or more planes may be involved as the abscess finds its way towards the skin or peritoneal aspects, on either of which it may ultimately discharge. The weakening of the abdominal walls after the occurrence of extensive suppuration is favourable to the formation of a ventral hernia. When the abscess is associated with a. perfora- tion of the intestinal tract, a ficcal fistula commonly results. Symptoms and Diagnosis.—The usual con-