A system of surgery : theoretical and practical . walls of the tube is destroyed, producing corresponding results. I maystate that, after the fiist accident, repair of the hole freqviently takes place, thewound of the integuments heals perfectly, and complete recovery ensues. After the second, however, the prognosis is not so favourable; for, commonly, anartificial anus is permanently established, and more or less of the contents of thealimentary tube are discharged thereat. As the result of long-continued constriction by the mouth of the sac, and thepressure made upon the two pieces of intest
A system of surgery : theoretical and practical . walls of the tube is destroyed, producing corresponding results. I maystate that, after the fiist accident, repair of the hole freqviently takes place, thewound of the integuments heals perfectly, and complete recovery ensues. After the second, however, the prognosis is not so favourable; for, commonly, anartificial anus is permanently established, and more or less of the contents of thealimentary tube are discharged thereat. As the result of long-continued constriction by the mouth of the sac, and thepressure made upon the two pieces of intestine lying therein, their walls becomeadherent at the points of contact, ulceration takes place, and the continuity of thetube is thus established within the abdomen, by the processes of nature alone. This 768 HEENIA. condition is very rarely met with, find I may therefore refer the reader to a publishedcase.^ Figs. 160, 161 show the appearances before described. Fig. 160.—Artificial Anus after Strangulated Ileum, at the convexity of the The patient, 72 years old, was the subject of strangulated femoral hernia for twodajs,but probably more, whenthe protrusion was returned by operation. The bowels acted freely by the anus, but on the fifth day from theoperation Itecal matter was discharged from the wound (b). Feeces continued to pass through it until death, whichtook place se-venteen days after the operation. The perforated bowel was the ileum, about a foot from the csecum,•which is seen in the woodcut (a). It is the mouth of the femoral aperture to show it more extravasation into the peritoneal cavity was prevented by adhesions between the margins of the perforation,neighbouring coils of bowel and omentum (c, rf). The patches or marks on the coil above and behind are the remainsof those adhesions. (Drawings, Jluseum &uys Hospital, 48G.) Fig. 161.—Illustrates that variety of Artificial Anus iu which the continuity of the tubeis destroyed
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