A case of contusion and rupture of the ileum : with peritonitis, without external wound, successfully treated by coeliotomy and primary enterectomy, followed by circular enterorrhaphy (Maunsell's method) / by Frederick Holme Wiggin.

  • Wiggin, Frederick Holme, 1853-
Date:
1894
Catalogue details

Licence: Public Domain Mark

Credit: A case of contusion and rupture of the ileum : with peritonitis, without external wound, successfully treated by coeliotomy and primary enterectomy, followed by circular enterorrhaphy (Maunsell's method) / by Frederick Holme Wiggin. 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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    marks of violence were found. The abdomen was tympanitic ; mus- cular rigidity was marked and increased by pressure, and especially at a point two inches to the right of the umbilicus. There was slight dullness on percussion at this point. The general abdominal pain had disappeared, vomiting had ceased, and the constipation was absolute. His countenance was drawn and anxious; the tempera- ture was 99'5°, pulse 190, and respirations 90. The diagnosis was intestinal rupture and general suppurative peritonitis. Although the prognosis was very unfavorable, 1 advised operation as the patient’s only chance. Coeliotomy confirmed the diagnosis. A large amount of pus was found in Uie cavity, shut off at various points by adhesions, and a rupture of the ileum, which was closed by Lembei’t sutures. The general cavity was washed out with a weak solution of hydrogen dioxide, the external wound par- tially closed, and drainage with iodoform gauze employed. The anaesthesia was badly borne; the patient stopped breathing and was revived with much difficulty during the operation. The operation was prolonged by the great intestinal distention, necessi- tating several incisions to allow gas and ftecal matter to escape be- fore they could be returned. The patient died six hours after the completion of the operation, which occupied two hours. Tlie chief points of interest in this case are: (1) The absence of shock ; (*2) the cessation of }>ain for twenty- four hours after the accident, although the intestine was so badly contused that it then became perforated ; (3) the energetic medical treatment employed for three days, and the consequent delay before surgical interference Avas considered ; and (4) the length of time required for the operation. Case II.—On the evening of September 11, 1893, 1 wiis called to see A. M., fifteen years of age, a colored boy. He gave the follow- ing history: On the afternoon of the same day, while in a pasture, he had rewived a kick from a horse on the right lumbar region and right elbow. He was found lying on his stomach, groaning. In about ten minutes he began vomiting, and complained of continuous nausea. At first he vomited only food, but later, both before being moved and after, he vomited each time about four ounces of dark, clotted blood.