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.

    9/18 (page 7)
    patient was first seen, four hours after the accident, the temperature and pulse being normal; (3) the excision of the contused and perforated portion of the ileum, and the end-to-end union by Maunsell’s method, which is compar- atively new, and has not been employed many times ; (4) the use of hydrogen dioxide in full medicinal strength for the purpose of disinfecting the general peritoneal cavity, this being the second successful case in which it has been used, the other being one of my own a few days previ- ously ; (5) the closing of the abdominal wound, leaving the peritoneal cavity full of hot, sterilized salt solution, the object of this being to lessen shock, to prevent adhe- sions, to aid in the readjustment of the intestines and omentum to their proper positions, to lessen the danger of septic peritonitis,* and to aid by osmosis the action of the bowels; (6) the shorter duration of the operation; and (7) in the after-treatment the early administration of peptonized food. In the first case the operation was performed after five days’ delay, having thereby been rendered more difficult, and requiring prolonged anaesthesia, which the large doses of morphine rendered more dangerous. The patient was exhausted from pain, constant nausea, and want of ' proper nourishment, and was septic. In the second, the early recognition of the condition, the comparative promptness with which the operation followed, its shorter duration, the use of hydrogen dioxide in full strength, the filling and closing of the peritoneal cavity with hot sterilized salt solution, made the difference between failure and success. A careful study of all the recorded cases, successful and unsuccessful, and my own, show the causes of failure of surgical measures to be (1) delay, which has been * BritUh Medical Jcnirnal, 1S92, Max Withard’s experiment.