The surgical treatment of intestinal perforation in typhoid fever / by Donald Armour.

  • Armour, Donald, 1869-1933.
Date:
[1903]
Catalogue details

Licence: In copyright

Credit: The surgical treatment of intestinal perforation in typhoid fever / by Donald Armour. 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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    in 61, in the caecum in three, in the appendix in three, and in the colon in five. Keen adds five more cases from other sources in which the perforation was in the colon, making ten in all, of which two were in the ascending colon, one was in the transverse colon, two were in the descending colon, and five were in the sigmoid flexure. He therefore concludes that if no perforation is found in the ileum, caacum, or appen ■ dix, the next most likely place will be the sigmoid flexure. In Shattuck’s 19 cases the ileum was the place of perforation in all of them. Finney says that it occurs in the ileum, usually in the last two feet, in over 80 per cent, of all cases, in the large intestine in more than 12 per cent., and in the vermi- form appendix in about 5 per cent, of all cases. It is usually single but may be double—a point to be borne in mind whenever operative procedure is undertaken. The involve- ment of the appendix in typhoid fever is of extreme interest and will be referred to later. Character of the perforation.—The aperture is sometimes exceedingly small and rounded, but may be linear if due to laceration. The perforation may occur in ulcers from which the sloughs have separated, or again, in certain cases the gangrenous process extends directly through the whole thick- ness of the bowel, and then the slough dropping out may leave a hole of considerable size. According to Osier only rarely is the perforation at the bottom of a clean thin-walled ulcer, the majority being in small deep ulcers. If the ulceration is in a solitary follicle, the perforation is apt to be small and round, while if in a Payer’s patch it may be oval or round and will be much larger than in the former case and may even involve one-half of the circumference of the bowel. The opening may be shreddy or clean-cut. Very frequently there is a fairly wide area around the ulcer in which the intestinal wall has been greatly thinned. From an operative point of view this is of great importance. Symptoms.—There is no pathognomonic sign of perforation nor is there any definite relation between perforation and the severity of the attack. It occurs in mild cases as well as in severe. Such symptoms as are usually described as being indicative of perforation may be entirely absent or remain latent. On the other hand they ihay be gradual in onset or appear suddenly. “The so-called characteristic symptoms are not invariably present, and when they are they may be 1® Surgical Complications and Sequela: of Typhoid Fever.