An essay on intestinal fistula / by Thomas Pridgin Teale. From the second volume of "The cyclopedia of practical surgery".

  • Teale, Thomas Pridgin, 1801?-1867.
Date:
1841
Catalogue details

Licence: Public Domain Mark

Credit: An essay on intestinal fistula / by Thomas Pridgin Teale. From the second volume of "The cyclopedia of practical surgery". Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

    18/46 (page 12)
    which they constitute the termination ; these pass back into the abdomen, and are lost among the convolutions of the canal. Between the two orifices, an angular fold, of greater or less projection, is placed edgeways. Formed by the intestinal coats to- wards the mesentery, the ridge comes nearer to the skin,in proportion as the lossof intestinal substance has been more considerable, and the change in the direction of the canal more marked. It is slight, and concealed in the depth of the funnel, when the intestine has been simply opened by a wound or a small mortification. It is very large, and advances to the level of the skin, when the whole cir- cumference of the bowel has been destroyed, so that the two ends meet at an acute angle. In the first case, there exists between the two ends of the bowel a channel more or less deep, capable of conveying the contents from the tipper to the lower end : this is the kind of intestinal fistula most easily cured. There is no vestige of such channel in the second instance ; the projecting ridge, placed be- tween the two ends of the intestine, forms an impassable barrier between them ; here the cure is more difficult. The ridge, although placed between the two ends of the bowel, does not divide the bottom of the funnel equally ; or, if this should be the case at first, the division be- comes unequal subsequently. Being fleshy and moveable, it is turned aside by the stream of matters coming through the end corre- sponding to the stomach, and pushed toward the anal extremity, contracting it, and acting as a kind of valve, which sometimes entirely shuts it. Hence the difficulty so often ex- perienced of discovering the lower or anal orifice of the bowel. Mr. Lawrence, in his valuable treatise on Ruptures, observes that the two portions of the bowel lie near together, but are not ad- herent ; they are separated by the ridge called by Scarpa promontorio, and by the French iperon. If we introduce a finger into each orifice, and bring the fingers together, they are separated merely by the sides of the two portions of intestine. When it is de- scribed that they are kept apart by an inter- vening partition, we must remember that there is nothing but the intervening tunics. We might pass an instrument from one end of the bowel into the other, and thus cause a direct communication between them, by per- forating their coats ; but as the bowels arc simply contiguous without adhering, we should make a double wound into the cavity of the abdomen '. The two extremities of the intestine at first resembling each other, soon exhibit striking differences. The superior portion stimulated by the transit of fecal and alimentary matters, not only maintains its natural size, but be- comes thicker and stronger. The inferior orifice, on the contrary, having ceased more or less completely to perform its natural functions, becomes atrophied to such a de- gree, that when the parts are examined, after the morbid condition has existed several years, it would, as M. Dupuytren has re- marked, be difficult to suppose that the two portions of the intestine belonged to the same individual. Notwithstanding this change which takes place in the coats of the lower portion of intestine, it still generally remains pervi- ous, and its lining membrane continues to secrete a whitish viscid mucus, which may remain in the canal for months or years with- out acquiring a feculent odour. The follow- ing case recorded by M. Dupuytren, how- ever, shows that obliteration of the lower portion of the canal is not impossible. An old man ', a patient of M. Begin, at the Val- de-grace, had, for more than forty years, at the left groin, an abnormal anus formed on the transverse arch of the colon. The superior opening of the intestine only could be detected. No opening corresponding to the inferior ex- tremity, could be discovered at the wound, in the cicatrix, nor in the surrounding parts. The lower portion of intestine, resembling a solid white cord, of the size of a goose-quill, ascended to the left kidney, and afterwards forming some turns, descended to the anus. At the lower part it was still open and con- tained whitish mucus. Above it was so con- tracted as only to admit a small probe, and still higher, in the neighbourhood of the accidental anus, no trace whatever of an in- ternal cavity could be discovered. The following figure, represented by M. Bourgery from a drawing in Dupuytren's col- lection, exhibits an instance of intestinal fis- tula, in which the lower aperture was closed by the projecting valve. Fig. 3. Intestinal fistula from Diqmytrc.n's collection. a, Upper portion of intestine. I/, Aperture of ditto. c, Lower portion of intestine, d, Projecting valve closiny the entrance to the lower portion of intestine.