Surgery of the Upper Abdomen (Volume 1) (Paperback)

This historic book may have numerous typos and missing text. Purchasers can download a free scanned copy of the original book (without typos) from the publisher. Not indexed. Not illustrated.1908 Excerpt: ... between the stomach below and the liver and diaphragm above. In Dujon's patient the great omentum, except at the pylorus, and the gastro-splenic omentum were torn off from their gastric attachment by the volvulus. He found that he could not produce this form of volvulus in the normal cadaver, unless the gastro-splenic and great omenta were ruptured. In Borchardt's patient the transverse colon maintained its normal position, but the gastro colic Fig. 29.--Wiesinger's Case Of Volvulus Of The Stomach. omentum, which was very broad, was stretched to its utmost. In most cases the spleen has been more or less displaced; it may be ruptured; and either from it or the gastric vessels, profuse hemorrhage into the peritoneal cavity may occur. Should the use of the stomach tube prove unavailing in relieving the distention, prompt operation is required. If the stomach is very tense, it should be evacuated by puncture or incision; when it becomes flaccid, the puncture should be sutured, and the volvulus should then be reduced, if possible. The surgeon must remember the most frequent form of volvulus (around a transverse axis), for it is often impossible to determine by inspection how the viscera came to occupy the positions in which they are found. The transverse colon should be sought: it usually will be found close beneath the liver or diaphragm, and the spleen may be beneath the ensiform process, in the neighbourhood of the gall-bladder, or even in the pelvis. The posterior wall of the stomach usually presents, and has to be tapped; then as the evacuation proceeds the site of puncture may become inaccessible, and Berg was forced to suture his first puncture before the stomach was half empty, and to make another incision in that part of the gastric wall which then beca...