On a case of internal strangulation of the bowel by a band, associated with a reducible hernia : successfully treated by operation, with remarks / by Thomas Bryant.

  • Bryant, Thomas, 1828-1914.
Date:
1867
Catalogue details

Licence: Public Domain Mark

Credit: On a case of internal strangulation of the bowel by a band, associated with a reducible hernia : successfully treated by operation, with remarks / by Thomas Bryant. 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.

    10/12
    q^YSK of INTlilltNAL STiiANGULATION. was slightly tympanitic, although not tender, for firm pressure could e'^asily be tolerated ; he had not passed anything by the bowel, nor any urine. A catheter was passed, but only an ounce'and a half was drawn off. It was too evident that he was sinking, and that any operative interference was clearly hopeless. He died eighty-eight hours after the first symptoms, and sixty-eight after the operation of herniotomy, in a severe paroxysm of pain in the epigastrium, attended with.vomiting. The necropsy revealed the true seat of the malady and that the hernia had nothing whatever to do with the symptoms. Some feet of the middle of the small intestines were found much distended, of a black colour, and almost gangrenous; they had evidently been strangulated by a small string-like band about an inch and a half long, which passed from a piece of intestine backwards to the mesentery near the promontory of the saerum. The division of this band at once freed the bowel, and it was clear that this operation could have been readily done during life. Remarks.—The analogy between the two cases I have related was so great that it was impossible for me in the first one, not to entertain the idea that the cause of the strangulation of the bowel was of the same character as the post-mortem examination of the last had revealed to me. In that case, when it was clear that the seat of strangulation was not in the parts which formed the hernia, the idea of opening the abdomen more freely than had been done in the herniotomy, with the view of giving relief, was entertained, but unfortunately abandoned; and when it could have been carried out the time for doing so had passed away, for the patient was at death’s door. But in the successful case to which I have drawn your attention no obstacle existed to prevent the adoption of the practice which had been sug- gested, and the result of the treatment must be regarded as being most satisfactory. In both cases there was distinct evidence of intestinal obstruction; in both the pain w'as situated in one spot, and was of a paroxysmal nature ; in both hernia existed, but in