Intestinal Surgery

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Bellamy ' has described a case of a very rare form of intestinal obstruction, due to invagination of a portion of small intestine in the walls of the rectum, successfully treated by abdominal section. The obstruction had been complete for nine days. The patient was a female who had been subject to obstinate constipation, and on three occasions the retention of f secal matter had given rise to serious symptoms, which, however, had always yielded to ordinary means. On admission into the hospital ...a hard swelling could be felt in the left iliac fossa, in the region of the inguinal canal and sigmoid flexure. Manual examination of the rectum disclosed an obstruc- tion in the upper part of this portion of the intestine. As the symptoms of obstruction became urgent and failed to yield to ordi- nary treatment, abdominal section was performed after exploration of the left external inguinal ring, which had been the seat of an old hernia, by enlarging the incision upwards and obliquely outwards. On introducing the hand into the abdomen it was ascertained that the swelling in the iliac region was composed of a knuckle of small intestine which was obviously invaginated in the anterior aspect of the first part of the rectum, and in- addition there was felt what appeared to the touch to be bands of organized lymph, stretching across in the same place, and probably the result of a former circum- scribed peritonitis.

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