Operation for artifical anus / By J. Mason Warren, M.D.

  • Jonathan Mason Warren
Date:
[1848]
Catalogue details

Licence: Public Domain Mark

Credit: Operation for artifical anus / By J. Mason Warren, M.D. Source: Wellcome Collection.

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    nature, which I had an opportunity of seeing abroad under the care of Dupuytren, the intestine opened on the surface of the abdomen by a large aperture, and there was no difficulty in exploring at once, the end of the bowel with the finger, or by instruments. In the present instance the fistulous openings ran in every direction ; those in the groin were immediately in the neighborhood of the probable orifice of the artificial anus, allowing a probe to penetrate for its entire length. I therefore determined to dilate the two latter openings, which was done very gradually by sponge-tents, on account of the sensi¬ tiveness of the patient to any manipulations, and it required the per¬ severing application of this method for a month, before the two ends of the intestine could be with certainty distinguished. This, how¬ ever, was finally accomplished, and a gum-elastic bougie passed into the upper and another into the lower orifices of the intestine. The bougie first penetrated through a thick callous mass of integu¬ ment, then through the muscular or tendinous covering of the abdo¬ men, in all about an inch in depth, when the septum or spur, as it has been called, which separates the two ends, was encountered and with difficulty entered, being so closely applied to the parietes of the abdomen as to prevent the least passage of matter from the upper into the lower part of the bowel. There had not been, in fact, for two months, the slightest fecal discharge per anum. The intes¬ tinal ends seemed to lie parallel to each other, so that the bougies introduced for exploring made but a very slight angle. The patient still remained nervous and quite feeble. I directed that the sponge-tents should be continued; also that a pint of oatmeal gruel should be given, per anum, daily, for the pur¬ pose, both of stimulating the intestinal coats to the performance of their natural functions, and with the object of enlarging the calibre of the bowel, which must have become much contracted from long disease. On the following day I found that some scybalse had come away with the enema ; and, on the next day, the injected fluid made its appearance at the apertures in the groin. In the course of a few days the principal opening had become so dilated, that by a steady and patiently applied force, I could insinu¬ ate the little finger quite down to the intestine. The septum could now be distinctly felt lying against the wall of the abdomen, and be hooked up, so as to permit the end of the finger to be carried into the lower portion. The sensation of the valve was that of a deli¬ cate membrane, like the coronary valves of the aorta, though some¬ what more resisting. A director was now carried down at the side of the finger for the purpose of keeping the valve open, a gum- elastic catheter passed in, and a quantity of warm water injected, to make sure that the lower orifice had been found. This water after¬ wards appeared, and was discharged per vias naturales. The patient being well prepared, I determined to apply the en-