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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    return of damaged bowel did not cause peritonitis and the line of suturing had remained sound. From the fact that she died at the end of six days from simple exhaustion and without post-mortem evidence of perito- nitis, I think we may conclude that the removal of an additional foot of intestine would have caused her death more certainly and at an earlier date. Case II was one in which primary resection was done after four days’ strangulation, and at the end of seventeen days an artificial anus was made on account of obstruction from kinking. And, again, after the lapse of another eighteen days the artificial aperture was closed by a third operation. Mrs. S., aged thirty-two, was sent to me by Dr. Creighton, and admitted into St. Thomas’s Home on September 30, 1893. She had had a right femoral hernia for eight years, but had never worn a truss. The hernia came down on the 27th, with symptoms of strangulation, pain, vomiting, etc. Taxis was employed unsuccessfully by Dr. Creighton, but, although repeatedly urged, she declined all operative interfer- ence till the day of her admission into the Home. The femoral her- nia was hard and tense, but without any external evidence of inflam- mation. Her temperature was 101.40, and she was collapsed and very feeble. The operation was at once commenced, and the sac opened. Adherent omentum was found, and behind this a knuckle of small intestine, which was dark, but with a good polished surface. The nar- row neck of hernia was incised, and the loop of small intestine gently pulled down. A rush of faecal fluid was at once seen to escape from an ulcerated opening at the seat of constriction. There were two deep grooves, at the bottom of which the bowel wall was obviously very thin. After disinfection the omentum was removed and the liga- tured stump returned. The opening into the abdomen was still further enlarged and more bowel withdrawn. The area involved by the two deep grooves, in one of which the opening existed, was then seen to be about one and a half inches in length. Beyond this the damaged bowel extended so far that it appeared to me to be unsafe to remove it in her collapsed condition ; for if more than one and a half inches were removed, then at least a foot should also be removed, for there was no choice between these two extremes. I thought, also, that the one and a half inches could be excised, sutured, and returned