A case of appendicitis in which the appendix became permanently soldered to the bladder, like a third ureter, producing a urinary fecal fistula / by W.W. Keen.

  • Keen, William W. (William Williams), 1837-1932.
Date:
1898
Catalogue details

Licence: Public Domain Mark

Credit: A case of appendicitis in which the appendix became permanently soldered to the bladder, like a third ureter, producing a urinary fecal fistula / by W.W. Keen. 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.

    9/12 (page 7)
    the spur with the scissors through the small fistula, lest I might open the peritoneal cavity or have dangerous hemorrhage. I also rejected Dupuytren’s enterotome, and finally decided upon the following plan: An elliptical incision was made around the artificial anus, and the abdominal wall was dissected back from the bowel about two and one-half centimetres away without opening the peritoneal cavity. The bowel was then slit enough to get my forefinger readily into its calibre, when the spur was drawn out through the opening and an operation identical with the Heineke-Mikulicz operation of py- loroplasty was done on the spur, the incision being made longitu- dinally and then converted into a transverse one and sutured with a continuous catgut suture. Several vessels bled quite freely and were ligated. I was able in this manner to determine by touch that not a vestige of the spur was left, and therefore that no obstacle to the pas- sage of feces remained. The artificial anus itself was now closed, first by a silk suture passed through all of the coats of the bowel and then by a continuous Cushing right-angle suture. The skin was then sutured by silkworm-gut. He made an uninterrupted recovery, the highest temperature being 99.8° F., and he left the hospital October 25 entirely well. The very afternoon that he left the hospital he began to have recurring pains in the abdomen, accompanied with constipation, but Dr. Service was not in the least alarmed about him till the evening of the 28th. I saw him on the morning of the 29th, and found that he had had repeated attacks of vomiting for two or hree days and that the bowels had not been opened, but that gas had passed freely. The belly was not distended or tympanitic, but his general condition was bad. There was more or less pain everywhere, but not at any one special point. Possibly, had he not already had so many operations done, I might have decided to do an abdominal sec- tion at once, but I confess that in the case of a man who had just got out of the hospital after four operations I hesitated greatly before recommending another operation, especially in view of the fact of the free passage of flatus and that the vomitus was distinctly not fecal. On the 30th there was practically no change in his condition. Early in the morning of the 31st I had an urgent call to see him imme- diately, and when I got there he was in collapse. Dr. Deaver kindly saw him with Dr. Service and myself, but we concluded that the only thing to be done was to give him a saline intravenous transfusion, in the hope that his condition would improve sufficiently to allow of a