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Show 1210 or run Inrnsrme. imagine it might be done. corner. or TIIE STRANGULATED Inrns'rina. 1‘)? Mr. Hey, however, found it im, practicable, and was obliged to stop it with graduated com- COLOUR. OF THE STRANCULATIZD ISTESTINE. press of sponges, over a dossil of lint. I HAVE seen the intestine very firmly strangulated by the OF THE IXTL'STINL. rifect of over-distension, with flatus, and the coats of their natural transparency and colour. lifnn intestine is to be gently and .uniformly pressed, by grasping it with the palm and fingers of one hand. Being gers; taking care that in trying to accelerate the entire re duetion, we do not push the finger too forcibly into the open- colour, with the veins turgid and distinct. to be replaced by the alternate pressure of the two fore-fin ing of the tendon, carrying the gut before it. ll£ That acci~ i dent may take place, the effects of which I have represented in a plate. When a portion of the intestine has been long in P carcerated, and yet is not strangulated or deprived of its eir» 1": hm wmmu‘. "in inn m w; «m of intestine which is included in a stricture, is of a dark red, approaching to a brown colour, and the substance of the coats much thickened by infiltration into their interstices; so that they acquire a lieshiness in their appearance. The first stage of strangulation is exhibited in a darl; red empty of llatus, the last portion of the gut which came out is i i But in general the portion cniation, it is apt to form adhesions ; and while the intestine included in the sac is passing rapidly to gangrene, the part embraced by the neck or" the sac adheres to the peritoneum. This, in one instance in operation with my friend Dr. (L‘heync of Leith, I separated with my finger. To apply the knife in this case 1 conceive is out of the question. Were the tendons and peritoneum to be cut up for some inches, and the belly exposed, it would be a hazardous dissection to separate the gut with the edge of the knife. If these adhesions are new, they may be separated by the finger; if confirmed, ,i is better, I think, to undo the stricture, and bring the inte: guiiicnts over the intestine in the best manner we are. able. My friend Mr. Lynn had a case in which, after reducing the gut, the symptoms did not remit, and the patient died The second is shewn by a darker brown, with somewhat of a purplish tint, and the disappearance of the blood-vessels on the surface. D'Iortification is distinguished. by a more lurid brown cclonr, and no fluid blood appearing when the surface is touched with the laneet. seen upon it. It is confirmed when black spots are W'erc I entirely to trust my own experience, I should say we could not return apiece of gut into the abdomen, which was unfit to be returned. For there are adhesions formed with in and at the mouth of the sac, at the same time that the intestine is proceeding to gangrene in the hernia itself. If a suspicious intestine be returnable--if there be a spot eVidently gangrened-I should recommend the needle and ligature to be simply passed through the coats of the intestine, so as to preserve that part of the gut Opposite to the ring.I doubt whether the occasion for cutting away an entire circle of the intestine, and the possibility of reducing the of the usual sitD ., oi strangulation. 0n dissection, it was dis« covered that the gut had been passed round a cord within the of the intestine is, in some cases, a cause of continued obstruction, af- bcily. Sometimes such circumstances may be detected, by introducing the finger as far as the part will easily admit after the reduction of the guts; \erg,‘ generally, if‘ I am to Juuge from dissection, the gut adheres cum o«_-lnnd the ring. I eicn suspect that this 311116310" ter the reduction. Inflammation is attended with an increase of the quantity of blood circulating. The state of the blood in the strangulated gut, i5 111% diminished freedom to the return by the veins, or total stagnation. Ac. incarcerated gut may be inflamed; but a strangulated gut does not "41‘ fer by inihnnna‘ion. Sec Mr. A Cooper, 1). 136- VlUNl mosh" f |
