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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    CHAPTER III. INTERNAL STRANGULATION. As a cause of obstruction, internal strangulation by bands, etc., ranks in order of frequency next to intussusception, contributing- more than 25 per cent, to these cases, or according to our own statistics 36 per cent, of classified cases. It occurs most frequently in males between the twentieth and fortieth year, and is, in the great majority of cases, due to the remains of a former peritonitis, thouo;h strano-ulation throuoh the foramen of Winslow, through the diaphragm, and into congenital or acquired peritoneal diverti- cula, particularly in the region of the iliac fossa and the pelvns, have been many times observed. In regard to the seat of internal strangulation the combined statistics of Duchaussoy, Besnier, and Haven give, in a total of 151 cases, the small intestines as involved in 133, and our own figures are in accord with this. Treves classes under the heading Hernia-like Strangulation of the Bowel :— 1. Isolated peritoneal adhesions, due to former peritonitis, and the subsequent drawing out of the organized lymph by means of the vermicular motion of the bowel into a cord, these bauds being generally single and attached by their two extremities to practically any portion of the parietal peritoneum or the abdominal viscera. When a short band stretches tightly over a firm surface the gut may slip beneath it and be strangulated. When there is a long band not very tense, and attached only by its extremities, looping or knotting may occur. Le Bedois' notes a case of strangulation by a band passing twice around a loop of the ileum, and Leichtenstern describes a mechanism by which the false ligament being sufficiently loose a true slip-knot was formed, in the loop of which the bowel was caught. He states that all these knots are characterized by the circumstance that the moment