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.

    8/10 (page 6)
    through the enlarged femoral ring, whereas the larger operation would involve the addition of an abdominal section, and the treat- ment of a large mass of mesentery. The portion already described as one and a half inches in length was therefore excised close to the mesenteric attachment and the mesentery doubled on itself, and kept in position by a few silk sutures. The two ends of small intestine were united by a double row of silk sutures, one for the mucous membrane and the other for the peritoneal and muscular coats, after Lembert’s method. After the completion of the operation there was a good deal of difficulty in returning the bowel into the abdomen. It required a free division of Poupart’s ligament before this could be satisfactorily ac- complished, and even then there must have been a good deal of strain by pressure on the sutures. The sac was then excised, and a drainage- tube passed up just within the abdomen. She vomited twice in the twelve hours succeeding operation ; but not again till the sixteenth day, when other signs of obstruction made their appearance. She was fed by nutrient enemata for the first three days, but on October 4 was fed by the mouth, and subsequently took fluid nourishment freely. On the 5th the bowels acted after an enenA, and continued to do so till the 16th. The temperature rose to 1020 F. the day following the operation, and after this varied from 98° to ioo° F. There was no abdominal distention till the 14th, when this symptom began to make its appearance. The bowels then also began to act less readily with enemata, and on the 16th she was sick. On the 17th she was again sick, and the abdomen was much more distended. She had had no action of the bowels for two days. I came, therefore, to the reluctant conclusion that she had obstruction from some cause connected with the seat of operation. The wound had given no trouble nor cause for anxiety, and at this time was dis- charging very little. October 17,3.30 p.m. The abdomen was opened in the mid- line, a little free fluid was found, but no pus, and no general adhe- sions. One distended coil of small intestine led directly down to the femoral ring, where it was firmly adherent. At this spot the bowel felt thickened, and the part beyond collapsed and empty. I feared, therefore, that my suturing had produced stenosis. The distended coil was therefore opened and the contents evacuated. On passing my finger down the inside of opened bowel I found that opposite the