Two cases of primary intestinal resection for gangrene of bowel from strangulation / by H.H. Clutton.

  • Clutton, Henry Hugh.
Date:
[1894]
Catalogue details

Licence: Public Domain Mark

Credit: Two cases of primary intestinal resection for gangrene of bowel from strangulation / by H.H. Clutton. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    ated, and a loop of small intestine found protruding from the femoral ring. • Nearly the whole of this loop was gangrenous and the rest covered with adherent lymph. It was over three inches in length, and could not possibly have been reunited after excision and then passed through the femoral ring, as the puckered mesentery of so much intestine would have been too bulky, even if the opening had been enlarged by a free division of Poupart’s ligament. The loop was therefore drawn down, and, after a ligature had been tied round at each end, the damaged bowel was excised. After thorough disin- fection and removal of sac an incision was made through the linea alba and the two ligatured ends of bowel withdrawn on to the sur- face of the abdomen. The proximal end, which was much distended, was allowed to discharge its contents into a porringer. It was then clear that at least a foot more of this end of the intestine should be excised, if absolute safety was to be secured from subsequent perfora- tion. This was felt to be impossible in the precarious condition of the patient, as the mesentery of so long a portion of bowel would of itself take a long time to treat; a wedge-shaped piece of mesentery corresponding to the absent bowel was therefore excised and the two ends of the intestine shortened as far as the temporary ligatures. The bowel was then reunited by two rows of silk sutures,—the first only for the mucous membrane, whilst the second was employed by the Lembert method for the peritoneal and muscular coats. A glass drainage-tube was inserted and the wounds closed in the ordinary manner. There was no sickness at any time after operation, and the temperature remained normal. The discharge from the drainage-tube was offensive the day after operation, and on the 20th became dis- tinctly fecal. At the same time there was an evacuation of some fluid per rectum. She died on the 21st, six days after the operation, without any abdominal distention or any sign of peritonitis, but from simple want of rallying power. Post-mortem by the late Dr. Hadden. No peritonitis; suturing of bowel perfectly sound ; intestine some distance above the line of suture presented a small round aperture from ulceration. This coil was deeply placed in the pelvis with a localized track leading to the surface where the drainage-tube had been placed. As the aperture did not involve more than a small portion of the calibre of the bowel, there is no reason why it should not have spontaneously closed. So far the post-mortem record is satisfactory,—that the