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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    3. Acute or chronic obstruction with tlie resultant jialliologif-al changes in the gut. LeDentu^ reports a case in which a wooden kitchen spoon per- forated the stomach within fifteen hours of its entrance into that organ, and passing between the two anterior layers of the omentum entered the general peritoneal cavity without producing symptoms of peritonitis. Prognosis.—This is usually favorable; considering the immense number of foreign bodies swallowed it is certainly the rare excep- tion in which obstructive symptoms are subsequently developed. Symptoms.—In addition to the history of a foreign body having been swallowed, of attacks of hepatic colic, or, where a gall-stone ulcerates through into the bowel, of some local peritonitis about the region of tlie liver, there can commonly be elicited a record of sharp colicky pains, of partial obstruction, and of vomiting. The distention is slight, the amount of sj'stemic shock far less than in other forms of obstruction, and the duration of the attack some- what longer than usually obtains in this class of affections. The symptoms of obstruction are freqently only partial, the vomiting being moderate in amount and not stercoraceous, the constipation not being absolute. Except in the case of enteroliths and very large foreign bodies a tumor can rarely be felt. Diagnosis.—It is often impossible to diagnose this form of obstruction from that depending upon a narrowing of the lumen of the bowel, such as cancer or stricture produces. The previous history is always of great importance. The presence of indican rather than albumin in the urine, the comparative mildness of the attack, the moderate meteorism, and the slower course of the dis- ease, all help to exclude internal strangulation or volvulus. It is, however, mainly upon the history that the diagnosis will be founded.' Treatment.—Where obstruction is fully developed and the diagnosis of foreign body in the causative role clearly established, 1 La Semaine med., Jan. 9tli, 1889.