. Annals of surgery . t which overlaid the caecum. The upper segment, dis-tended in the right flank, became collapsed and flattened as it passedunderneath the inferior segment, and on the further side of it, itdilated again and formed an angle to come and open at the wound. The mechanism of the obstruction in this case is practicallyidentical with that in the preceding. The difference lies, first,in the twist which in this instance was a complete one from leftto right, and in Case IX only a half-twist, and from right to left,and, secondly, in the small size of the involved loop. VOLVULUS IN AS
. Annals of surgery . t which overlaid the caecum. The upper segment, dis-tended in the right flank, became collapsed and flattened as it passedunderneath the inferior segment, and on the further side of it, itdilated again and formed an angle to come and open at the wound. The mechanism of the obstruction in this case is practicallyidentical with that in the preceding. The difference lies, first,in the twist which in this instance was a complete one from leftto right, and in Case IX only a half-twist, and from right to left,and, secondly, in the small size of the involved loop. VOLVULUS IN ASSOCIATION WITH HERNIA. 423 The gangrene of the herniated portion was clearly due tocauses peculiar to hernia, but the obstacle to the progress ofthe intestinal contents produced by the twist no doubt deter-mined it. The continuation of the obstruction here was due to thelower limb of the twist acting the part of a band, its two endsbeing- fixed, one at the caecum and the other at the artificial ™.>^-„«^ Caecum. ARTlflClAL 4.—Diagrammatic sketch of the conditions described in Case X. anus. It is impossible to say how far the conditions might haveapproximated to those met with in strangiilation by volvulus, ifthe artificial anus had not been formed and distention of theloop had not been prevented. Case XI.—Dr. Dreesmann. Berliner klinische Wochenschrift, , April 17, 1899.—A woman, aged thirty-seven, for ten years hadhad a swelling in the right groin which went back after rest in bed. 424 B. LAWFOBD KNAOOS. It gradually increased, but she never wcffe a truss. On May 6, 1898,it could not be replaced, and the same night pain and vomiting setin. She was admitted to hospital next day. The hernia was the sizeof two fists, and tender. Pulse 160. Under anaesthesia the rupturewas only slightly reduced by taxis. Herniotomy was performed. Onlaying the sac open offensive dark-colored fluid escaped. The loopsof gut were dark black with dull surface. The gangrene e
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Keywords: ., bookcentury1800, bookdecade1880, booksubjectsurgery, bookyear1885
