The surgical treatment of wounds and obstruction of the intestines / by Edward Martin and H.A. Hare.

  • Martin, Edward, 1859-1938.
Date:
1891
Catalogue details

Licence: Public Domain Mark

Credit: The surgical treatment of wounds and obstruction of the intestines / by Edward Martin and H.A. Hare. 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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    the gut is released from their bight they can immediately be drawn out by pulling each end. 2. Strangulation hy cords foymed from, the omentum.—Tnflannna- tory adhesions, due either to traumatism or to involvement in peritonitis, are the beginning points of the thick strong omental cords. These are commonly found attaclied about the region of the internal inguinal ring of the left side. They are somewhat larger and looser than the isolated peritoneal bands, and hence more frequently form knots. 3. Strangulation hy Ifeekel's diverticulum.—The vitelline pedicle attached in the embryo to the lower fourth of the iknim sometimes persists, and may, exceptionally, exhibit all the features of normal intestine. Thus Cruveilhier's^ operation was unsuccessful because from the size and appearance of the constricting diverticulum it was taken for the intestine. More commonly it is represented by a blind tube or fibrous cord, two or three inches in length. The extremity of the diverticulum may be attached or remain free; if attached primarily, it will be found at or just below the position of the umbilicus. This attachment may be ruptured and secondary adhesions take place in nearly any part of the abdomen. The diverticulum is found to be much more common in the male than in the female. In addition to the true Meckel diverticulum there are certain pouch-like extensions from the bowel, sometimes occurring in great numbers, and which may, by contracting adhesions with surround- ing parts, or with each other, cause strangulation of the bowel. It is well recognized that these pouch-like extensions of the gut are particularly prone to take place into the substance of the epiploic appendages of the colon. This probably was the condition of affairs in a case reported by Holmes.^ The bowel was strangulated by a ring formed by two adherent appendices epiploicse. These false diverticula are usually rounded or saccular in shape, and are subject to inflammation from lodgment of undigested food, fruit-stones, etc. 4. Strangidation by normal structures abnormally attached; and through slits and apertures. In the first caption of t-his form of internal strangulation the vermiform appendix is chiefly at fault. It sometimes attains the 1 Gaz. des Hop., 1872, p. 102. 2 Tr. Path. Soc, Loud. 1860-61, xii., iii.