Imagens das páginas
PDF
ePub

undertake it at the urgent entreaties of the relatives of the child. He should distinctly state the uncertainty of a successful issue, and what will be the after condition of the patient if it survives. The manner of performing the operation is as follows: The child being placed on a pillow, an incision about two inches in length is made midway between the anterior superior spinous process of the ilium and the pubis, a little above Poupart's ligament, in a direction parallel with the course of the epigastric artery; the integument, the several layers of muscles, and the transversalis fascia are to be divided; the peritoneum being exposed, is to be pinched up, and an opening made by cutting horizontally through it; a director. or the finger is then to be passed into its cavity, and the incision enlarged to the extent of the external one. If the intestine be now seen, it is to be brought close to the wound, and two double ligatures, near to each other, are to be passed through it, by which the intestine is to be secured to the margins of the abdominal opening; after which, by making a longitudinal incision between the ligatures, the meconium will escape. If the child live, adhesive inflammation is set up between the peritoneal surfaces in apposition, and closes external communication with the cavity. The evils to be afterwards contended with are, a tendency in the external opening to

close, the protusion of the mucous membrane of the bowel, and excoriation of the integument from the irritation of the excretory matter, and the friction of the bandages, or apparatus used, to occlude the opening.

UNNATURAL TERMINATIONS OF THE RECTUM IN THE

BLADDER AND URETHRA.

In

The rectum, instead of terminating at the anus, is sometimes prolonged forwards in the form of a narrow tube, and opens into the posterior part of the urethra. This malformation is more common in males than females; and in the former is more likely to be fatal, from the length and narrowness of the urethra. most of these cases of malformation, some imperfection of development coexists, especially of the genitourinary organs. The opening of the intestine is usually very small, and permits only the more fluid portion of the meconium to be evacuated.

In other instances, the intestine opens into the bladder somewhere between its neck and the part where the ureters enter: in such cases the meconium and urine will be mixed; but when the opening is urethral, a jet of meconium, or fæcal matter, will generally precede the urine.

In this species of malformation, the opening for the discharge of the contents of the bowel being so small,

the child rarely survives more than a week, but instances are recorded of life being prolonged beyond that. Fortunatus Licetus mentions a woman who voided her fæces through the urethra. Flagini + relates the case of an infant in whom about three inches of the rectum was wanting, the intestine terminating in a canal four inches in length, which passed under the prostate gland, and opened into the membraneous portion of the urethra. The stercoraceous matter of course was voided with great difficulty by the urethra; nevertheless, the miserable babe lived eight months, and then only died in consequence of having swallowed a cherry-stone, which lodged in the recto-urethral canal. Bravais records the case of a boy four years and a half old, in whom the rectum, after becoming very narrow, opened into and appeared continuous with the urethra. Paulletier § also saw a similar case in a boy three years and a half old.

Mr. Copland Hutchinson || operated on a male child, born forty-eight hours. An incision was first made to

*De Monstrorum Causis Natura et Differentiis,' lib. ii., cap. liii.,

6

1616.

Observazione di Chirurgia,' tome iv., obs. 39.
Actes de Lyon,' tome iv., p. 97.

§ Diction. de Science Méd.,' tome iv., p. 157.
Op. cit., p. 264.

the depth of an inch and a half, then a trocar and canula were inserted another inch and half, when the intestine was reached: the opening was maintained by tents and bougies. After three months, the urine was observed to be tinged with fæces: it had not been observed to pass per anum. The child died when about ten months old, from the irritation of dentition. An examination revealed a valvular opening between the rectum and commencement of the urethra.

Mr. Fergusson* reports a very interesting case of a male child, born twelve hours previously to coming under his observation. No anus existed, but the skin where it should have been had a brownish appearance; above this, at a considerable distance from the surface, an indistinct tumour could be felt. An incision was made to the depth of an inch and a half, but the bowel was not reached, nor could it be felt. The next day, meconium being observed to pass by the urethra, Mr. Fergusson determined to cut into the bladder, and he opened this viscus immediately behind the prostate. The boy died of disease of the lungs, when about six years old.

Mr. Windsor,† of Manchester, relates a case of

* Edinburgh Medical and Surgical Journal,' vol. xxxvi.; and Practical Surgery,' Third Edition, p. 740.

† Ibid., vol. xvii., p. 361.

ascites in a fœtus born at the full period: there was malformation of the rectum, and other viscera, and absence of the anus. The colon was nine and a half inches in length: it passed in a straight line down the spine, terminating in a constricted tube, which barely admitted the passage of a blowpipe: this constricted part opened into a pouch the size of a hen's egg, occupying the portion of the rectum, and between which and the bladder a communication existed by a canal half an inch in length.

Mr. Randolph, of Hungerford, records in the Lancet,'* the particulars of a male child born without any opening in the anal region. Small quantities of meconium were observed to pass per urethram. The infant died on the ninth day. No operation was undertaken for its relief, as the mother objected. By examination after death, the rectum was found to open into the bladder immediately posterior to the prostate gland.

Mr. Lizars,-quoted by Mr. Fergusson,†-made an opening into the rectum of a child born with imperforate anus; he had to cut deeply before the intestine was reached. A communication between the rectum and bladder existed. The child lived three weeks; from the time of its birth, a tumour existed over the

* Vol. i., 1838-9, p. 162.

† Edinburgh Medical and Surgical Journal,' vol. xvii., p. 367.

« AnteriorContinuar »