Persistent omphalo-mesenteric remains : their importance in the causation of intestinal duplication, cyst-formation and obstruction / by Reginald H. Fitz.

  • Fitz, Reginald H. (Reginald Heber), 1843-1913.
Date:
1884
Catalogue details

Licence: Public Domain Mark

Credit: Persistent omphalo-mesenteric remains : their importance in the causation of intestinal duplication, cyst-formation and obstruction / by Reginald H. Fitz. 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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    oesophagus. In each instance the wall was lined with cylindrical epithe- lium. In the case reported by Roth the wall had the structure of the intestine, with a predominant development of muscular tissue. The pos- sibility of the origin of these cysts from a diverticulum is to be recog- nized from what has already been stated with reference to the longitudinal differences in the place of insertion of the vitelline duct. Hennig attri- butes the origin of the cyst reported by him, which was between the third and fifth cervical vertebrae, to the persistence of a portion of the branchial fissure. Cysts with a structure resembling that of the intestine are sometimes to be met with in the abdominal wall, in the vicinity of the umbilicus. Their presence in this region suggests at once their origin from a portion of the vitelline duct included within the abdominal wall. The same statement applies to the origin of the adenomata of the navel, described by Kiistner.1 The evidence presented lacks the clinching fact, however, since the reported instances of the cysts and the growths occurred in indi- viduals living at the dates of observation, and there is no evidence to show the relation between the intestine and the posterior surface of the abdominal wall. Roser2 reports the case of a male patient, said to have had a tumour in the region of the navel, which had been opened. A slimy, watery dis- charge from the opening followed the operation, and relief from the fistula was desired. A sound entered a spacious cavity about 6 cm. in diameter. The discharge contained cylindrical epithelium. An incision through the skin disclosed a wall of dense fibrous tissue. When this was cut through there appeared a cavity lined with mucous membrane. As much of the latter as possible was removed, and on examination was found to contain Lieberkiihn’s glands. Healing, with the formation of a scar, took place after forty-eight days. A cyst of the abdominal wall an inch above the navel is reported by Wy ss.3 It was of the size of a bean, and lay between the muscle and peritoneum. The contents were an opaque viscid mucus, and its wall, composed of dense fibrous tissue, was lined with ciliated epithelium. If this cyst were of vitelline origin, as its situation suggests, the inclusion is likely to have taken place at an early period of foetal life. The presence of ciliated epithelium in the primitive intestine is evident from the investigations of Neumann and lvolliker,4 and its existence in intestinal cysts has already been mentioned. The clinical importance of these intestinal cysts obviously depends upon 1 Kiistner, Virchow’s Arcliiv, 1877, Ixix. 286. 2 Roser, Archiv Itir klinische Chirurgie, 1876, xx. 475. 3 Wyss, loc cit., 143. 4 Kolliker, Entwickelungs-gescliichte dcs Menschen und der Hoheren Tliiere, 1879, 853.