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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    1G thread-like process with a knobbed end from the mesentery near the in- testine, and a short distance above the caecum. The statement is then made by him that floating threads with rounded ends may often be found in the mesentery, or near the navel, which are to be attributed to omphalo- mesenteric vessels, or the duct. Immediately after my attention was directed to' this point, on examination of the body of a man who died from chronic tuberculosis at the Massachusetts General Hospital, there were found two tuft-like projections from the upper surface of the mesentery, each a half-inch long and about a half-inch apart. They were about two inches distant from that portion of the ileum lying some three feet above the ileo- caecal valve. The peritoneum covering them was normal in appearance, and the mesentery elsewhere was free from all abnormal changes. The peritoneum in the vicinity of the navel was examined, but with negative results. Since then repeated examinations have been made with reference to what might be regarded as vitelline remains, but with indifferent success. One of the most remarkable instances of a persistent omphalo-mesen- teric vessel must be sought for among the earlier observers. The recent discoveries have been made in the bodies of foetuses and new-born chil- dren. Spangenberg,1 however, found in the body of a young man twenty years of age, what he regarded as an open omphalo-mesenteric vessel. “It could be followed to within a half inch of the navel, where it became a delicate ligament and was lost in the umbilical ring. It descended from the navel, between the epigastric veins, on the posterior surface of the peritoneum, to which it was united by fibrous tissue, to nearly midway between the umbilicus and pubes. Then, leaving the wall of the abdomen as a thin round cord, and crossing its cavity between the coils of small intestine, it passed beneath the lat- ter towards the spine, rather to the left, and emptied into a bifurcation of the main trunk of the superior mesenteric vein. The vessel was wholly free throughout its entire course, nowhere adhering to the intestine, and was envel- oped in a fibrous sheath. It was open to within two inches of the navel, and a small quantity of thin blood from the mesenteric vein was admitted as far as its middle. Its coats for three inches from its origin from the mesentery were collapsed like those of any other vein ; but from this point onwards it was of denser structure, and very smooth externally. It had no branches and its texture resembled in all respects that of the umbilical vein; which latter was found open through half its course. The appearance of the navel as seen from without did not vary from that of other normally formed umbilical depressions.” The existence of the omphalo-mesenteric vessels, their relation to the omphalo-mesenteric duct, and their occasional persistence entire or in part were well known to Meckel. Their transformation into fibrous cords was likewise familiar to this author. lie says,2 “Quite recently I found them in a child of three months arising, as usual, from the superior mesenteric artery and vein, running along the entire length of the diverticulum and converted at its end into a solid thread, several inches long and hanging free.” 1 Spangenberg, Deutsches Archiv fur die Physiologie, 1819, v. 88.