Synopses & Reviews
Synopsis
Excerpt from Stricture of the Rectum: A Study of One Hundred and Thirty-Eight Cases
Of the rectum are those made into and through the wall Of the bowel which are not continued to the surface - dangerous both from hemorrhage and sepsis. In the only case in which I ever performed this partial incision it was followed by a dan gerons pelvic inflammation.
The external Operation, on the other hand, provides for the control Of hemorrhage and for drainage in the most perfect way, and is therefore much safer though more extensive.
The originators Of this Operation employed either the Paque lin cautery knife or the chain ecraseur for the incision, both Of them being bloodless; and in my own first cases I used the cautery. But the bleeding with the external operation is not a matter to be feared, being easily controlled by packing the incision with charpie, and I now use a straight, blunt-pointed bistoury passed into the bowel and through the stricture on the left index finger as a guide. Care Should be taken to have the incision reach well above and well through all the strie ture tissue, and to be as nearly as possible in the median line behind.
The danger Of subsequent incontinence from this incision, if the sphincters are in good condition when it is made, is not very great; but the wound at the anus generally takes many weeks to heal and this is a great Objection to it. There are two ways Of avoiding this. One suggested and practised with good result by Weir is to confine the incision to the stricture, leaving the anus intact; and to drain this incision by a tube brought out through the Skin at the tip Of the coccyx. This I have tried in several cases with the result Of saving much time. The tube should be left in till all danger of periproctitis has passed. If there be no rise of temperature by the fourth day it may be safely removed, and the wound caused by it will generally heal promptly.
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