. Annals of surgery . ^^^ _TlecVof pouch Po\ K Fig. 6.—Situation, shape, and size of diverticulum in Case II. of operative treatment. It could not be positively asserted thatthe obstruction w^as due to a pouch. On the other hand, the dura-tion of the symptoms seemed to rule out obstructions of malignantorigin. A benign stricture of the oesophagus, with dilatation justabove the plane of constriction, would explain all the symptoms. Gastrostomy was considered, as was also inversion of thepouch and suture according to Girards method,—an operation 53^ MAURICE H. RICHARDSON. which will be descri
. Annals of surgery . ^^^ _TlecVof pouch Po\ K Fig. 6.—Situation, shape, and size of diverticulum in Case II. of operative treatment. It could not be positively asserted thatthe obstruction w^as due to a pouch. On the other hand, the dura-tion of the symptoms seemed to rule out obstructions of malignantorigin. A benign stricture of the oesophagus, with dilatation justabove the plane of constriction, would explain all the symptoms. Gastrostomy was considered, as was also inversion of thepouch and suture according to Girards method,—an operation 53^ MAURICE H. RICHARDSON. which will be described later. This operation was, however,deemed impossible, as it was apparent that, even if inversion couldbe successfully accomplished, the lumen of the oesophagus wouldmidoubtedly be practically closed. Excision of the pouch wastherefore decided upon, and on May ii. 1899, the operation was])erforme(l. Post A/Le \i\ ofP>i ciy. ^ ^\ X of Po-uch. p^i5lG\iS Fu;. 7.—.Same; posterior view. Case II. The oesophagus w^as readily found by a dissection of the neckthrough an incision five inches in length along the anterior borderof the left sterno-cleido-mastoid muscle. No important structurewas divided except the anterior belly of the omohyoid muscle. Apouch was discovered Ijehind the upper portion of the oesophagus. (ESOPHAGEAL DIVERTICULUM. 537 The base of the pouch was attached at the posterior surface of thebeginning of the oesophagus and the lower border of the pharynx(Figs. 6 and 7). The fundus of the pouch was easily separatedfrom the prevertebral space, and withdrawn from the wound at aright angle with the oesophagus. The pouch was opened and ex-plored, as in the preceding case. With the finger in the pouch,the probang introduced through the mouth could be guided into
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Keywords: ., bookcentury1800, bookdecade1880, booksubjectsurgery, bookyear1885
