A case of typhlitis, with double perforation of the caecum, and peritonitis : in which laparotomy and suture of the gut were followed by recovery / by L.S. McMurtry.

  • McMurtry, L. S. (Lewis Samuel), 1850-1924.
Date:
1888
Catalogue details

Licence: Public Domain Mark

Credit: A case of typhlitis, with double perforation of the caecum, and peritonitis : in which laparotomy and suture of the gut were followed by recovery / by L.S. McMurtry. 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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    form appendix was found to be normal. Upon tlie anterior and external surfaces of the caecum were two gangrenous perforations, one being somewhat larger than a twenty-five cent piece, the other a little larger than a ten-cent piece. These perforations were black and of well-defined circu- lar shape. The larger perforation was complete, and allowed free exudation from within the gut. The smaller one was scarcely complete, but the tissues were rotten, and upon slight pressure al- lowed my little finger to slip into the cavity of the gut The lesions were typically those of perfora- tive peritonitis. With the scissors I trimmed off the edges of the perforations, removing the gan- grenous tissue and converting them from circular to elliptical shape. The openings were then closed with silk sutures applied after Lembert’s method, five sutures for the larger and three for the smaller opening The tissues of the gut were thickened with inflammatory exudation. The sutures passed beneath the muscular coat but did not penetrate the mucous membrane. The toilette was made with scrupulous care. The diseased parts and the entire iliac fossa were carefully cleansed with wann carbolized solution (i to 40), and a large- sized rubber drainage-tube placed deep 111 the iliac fossa. The wound was closed with silk sutures, dusted with iodoform, and dressed with antiseptic ^ Immediate improvement followed the operation. Neither vomiting nor intestinal haemorrhage re- curred The after-treatment was conducted in accordance with the methods commended by re- cent clinical experience in cases of abdominal section. Within a few hours after the operation the pulse and temperature fell to almost the nor- mal Standard, and so remained, with the excep- tion of a few hours on the third day when the