. Annals of surgery . ittle sleep, but the intense agony was relievedand several feculent motions and much sanious fluid were passed inthe bed during the forty hours which elapsed before death took place. The post-mortem report is not forthcoming. In the absence of post-mortem information the followingexplanation is suggested with reserve. The irreducible state ofthe hernia and the presence of several large loculi occupied bybowel sufficiently prove that in this instance the volvulus was VOLVULUS IN ASSOCIATION WITH HERNIA. 417 not the result of a recent twist. When the bowel entered thesac fo
. Annals of surgery . ittle sleep, but the intense agony was relievedand several feculent motions and much sanious fluid were passed inthe bed during the forty hours which elapsed before death took place. The post-mortem report is not forthcoming. In the absence of post-mortem information the followingexplanation is suggested with reserve. The irreducible state ofthe hernia and the presence of several large loculi occupied bybowel sufficiently prove that in this instance the volvulus was VOLVULUS IN ASSOCIATION WITH HERNIA. 417 not the result of a recent twist. When the bowel entered thesac for the last time it did so in a reversed position. As more and more of the reversed loop became engulfedin the rupture, the ends would become approximated and cross,and so be brought into a condition of volvulus. The tractionexerted by the dependent tumor is a matter of great importancein this instance, and the atrophy of the mesentery lying in theneighborhood of the ring, which usually takes place in old- UMBILICALSAC. Fig. I.—Diagrammatic sketch of the probable arrangement ofparts in Case VIII. standing irreducible ruptures, would lead to that narrowing ofthe mesentery and approximation of the two ends of the loopwhich are such important features in the development of vol-vulus, and which at the operation were seen to be present inthis case. In the accompanying sketch an attempt is made to illus-trate the probable arrangement of parts within the abdomen. 4^8 R. LAWFORD KNAGGS. It will be seen that the upper limb of the twist acts as aslack wire or band, being certainly fixed at the ring in conse-quence of the irreducible nature of the hernia, and probablyfixed at its other extremity in some way or other which is notdifficult to imagine. The intra-abdominal portion of the lower limb—much thelonger of the two—hangs over this band, and a trivial circum-stance, such as an attack of flatulence due to an indigestiblemeal, would, by the tightening-up effect it would have upon t
Size: 1625px × 1537px
Photo credit: © Reading Room 2020 / Alamy / Afripics
License: Licensed
Model Released: No
Keywords: ., bookcentury1800, bookdecade1880, booksubjectsurgery, bookyear1885
