A successful case of lumbar colectomy, or excision of a stricture of the descending colon through an incision made for a left lumbar colotomy : with remarks / by Thomas Bryant.

  • Bryant, Thomas, 1828-1914.
Date:
1882
Catalogue details

Licence: Public Domain Mark

Credit: A successful case of lumbar colectomy, or excision of a stricture of the descending colon through an incision made for a left lumbar colotomy : with remarks / by Thomas Bryant. 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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    every four cases is located in the descending colonj and that about one third of these cases is of an annular or local character, I am. disposed to think that the instances in which this operation may have to be considered are not few. It should also be remembered that of all strictures of the large intestines other than those clearly due to inflammatory or syphilitic causes, the annular approaches in its histological as well as clinical features the simple growths; and that whilst, on the one hand, the histologist describes them as being composed of epithelial, cylindrical, 1 or adenoid elements, the pathologist will demonstrate the ! hard clinical and pathological fact that such growths are ( rarely attended with any metastatic or other disease, and I are for the most part local. Under these circumstances I submit that the expediency j of removing the strictured bowel, where practicable, is i more than demonstrated, and I think I may add that the [method of doing so by the operation I have brought under your notice will prove to be the best means, j Should this opinion be accepted, some change in practice Imay be required, for it would be wise to entertain the operation of excision of the stricture at an earlier period of its progress than it has hitherto been the custom for physicians or the majority of surgeons to entertain that of colotomy. Since the operation of excision of the stricture would be more readily performed when the bowel above the stricture was undistended and compara- tively healthy than when it was full of retained faeces and probably ulcerated from over distension. The operation, moreover, when performed under these more favorable circumstances, would be safer, since with healthy bowel above and below the strictured segment the surgeon may j with more confidence draw the diseased portion upwards ] from the pelvis or downwards and backwards from the i splenic region, a,nd consequently remove it with greater E safety and facility. The consideration of the operation of excision in any