A Case of Acute Intestinal Obstruction

A Mahommedan boy of about 14 years of a"-e was brought to me on August 20th, 1922, suffering from general peritonitis, probably of appendicular origin, and practically moribund. I opened one internal saphenous vein in front of the ankle and ran in 1^ pint of saline-glucose and brandy and adrenalin whilst getting ready for operation. Under local analgesia I opened above the pubes and put a large rubber tube into Douglas' pouch and another tube into the peritoneal cavity from each loin. There was a free discharge of stinking pus from the first, but only bloodstained, fluid from the others. He was put into Fowler's position, given water in large quantities and the pelvic tube sucked out frequently. After about four hours he seemed to have turned the corner and he left the nursin"home in about three weeks. On September 22nd, I found him to be suffering from pain and vomiting and advised his imme^ diate return. On September 23rd at 9 p.m I received a telephone message from the family doctor that the boy had complete obstruction and he was bringing him for immediate operation. I waited till midnight and then retired to bed. Next day at noon he was brought and his'condition was very bad owing to incessant vomiting. The distension appeared limited to the region of the umbilicus and was not excessive. I was just about to put him on the table when his wealthv grandfather decided that it was not worth while spending any more money on the boy and took him away. At 3 p.m. on the 24th he was brought back by the family doctor. His condition was desperate but not so bad as when he first came in August' I opened the other internal saphenous vein^and ran in saline and glucose whilst operating. Spinal analgesia was given and the abdomen opened in the middle line. I found a coil of small intestine acutely kinked by adhesions to the abdominal wall in the region of the spleen. These were gently broken down and the coil brought outside A small incision was then made and a loop emptied. The bowel wall was very rotten and was sutured with great difficulty. I then opened another coil, and whilst emptying it the peritoneal coast stripped of itself over a circular area about J 2 inch in diameter. There were black patches in the wall of other coils and one came to the conclusion that the case was utterly hopeless. I cobbled the opening as well as I could, but did not think it was watertight. No attempt could be made to close the peritoneum over this raw surface. The abdomen was rapidly closed and at the parents' request the patient was taken home in the car to die.