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.

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    way, some days after operation, at a distance from the site of reunion which has remained sound. This undoubtedly means that the bowel distended above the actual seat of strangulation was not sufficiently sound to maintain its vitality after its return to the abdominal cavity. A wider resection is the answer at once made to meet this danger. But those who have seen many of these cases will be aware that at least twelve inches may be in this doubtful condition and require resection, if this rule were always followed, when the part actually engaged in the constric- tion is perhaps not more than an inch or two. To deal with a mesentery twelve inches in length will materially add to the shock, and thereby increase the risks attendant upon the worst danger, after gangrene of bowel, with which we have to meet. Other cases of primary resection have been followed by obstruction, either from kinking at the seat of reunion, or from stricture, by folding in too much of the intestinal wall in the application of the sutures. Failure of union after suturing in damaged bowel, paralysis, and peritonitis apart from ulceration, have also to be reckoned with. Altogether, the operation of primary resection for strangulated hernia in a patient suffering from collapse has to be considered as a highly dangerous pro- cedure, only to be countenanced by its success in actual practice; and success must be shown to be obtained more frequently by primary resection in an equal and a large num- ber of cases than after an artificial anus and a secondary resection. But it is possible that a third course may be the best where extreme collapse contraindicates a primary resection,—namely, an artificial anus as immediate treatment to be followed by sec- ondary resection, at an interval of a few days instead of some weeks or months. Some may think this third course a distinction without a difference; but it is desirable that a very marked distinction should be drawn between what is ordinarily understood as a secondary resection and what is here proposed. A secondary resection is generally undertaken after some weeks’ interval, when the bowel