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Colitis Treated by Valvular Colostomy and Irrigation



Dr. Percy Bolton presented a man, forty-two years old, married, a carpenter by occupation. His family history was nega tive; the patient denied a venereal history, and had always en joyed good health up to the onset of his present illness.

Eight weeks before his admission to hospital, he was taken suddenly ill with vomiting and diarrhcea. The vomiting ceased after twenty-four hours, but the diarrhea persisted; the stools consisted chiefly of mucus and blood, and contained comparatively little faecal matter. There was marked tenesnius, and the stools were very frequent, as often as once every ten minutes. He had lost thirty-one pounds in flesh, and was much emaciated and very anemic. Upon his admission to hospital, his temperature was 97.8° F.; pulse, 104; respirations, 20. His bowels moved from sixteen to twenty-three times daily ; the stools contained much pus and mucus and a few red blood-cells ; no amcebx coli. A rectal examination of the lower fourteen inches of intestine with Kelly's speculum showed that the mucous membrane was studded with numerous small ulcers.

Dr. Bolton said that, following a suggestion made by Dr. Gibson, he determined to treat this case by irrigation through a valvular fistula of the czcum, made in the same manner as that commended by Kader, and so successfully practised in the forma tion of gastric fistulm; thus avoiding the discomforts attending the presence of an artificial anus. The abdomen was opened on the right side by a one and one-half inch incision parallel with and to the inner side of the outer end of Poupart's ligament. After uniting the skin and peritoneum with sutures of fine chro mated gut, the cmcum was drawn into the wound and held there by two silk ligatures which were passed through its serous and muscular coats, one on each side. A good-sized catheter was inserted into the cmcum, and the intestinal wall infolded about it by three superimposed tiers of Lembert sutures, the ends of the last set being passed through the abdominal wall and tied, fixing the cmcum securely. Sutures of silkworm were placed at each end of the wound.

After the operation the patient was put on a proteid diet. He was given a certain amount of salol every day, together with castor oil. The intestine was irrigated twice daily through the catheter, a x to to,000 silver nitrate solution, followed by a saline solution, being employed. After the seventh day the cathe ter was removed and introduced at the time of irrigation only, the valvular action of the opening into the gut being perfect, allowing no escape of fluid. Under this treatment, the blood, pus, and mucus disappeared from the stools, and at the end of two weeks the ulcerations of the intestine had healed. The number of the stools was reduced to one to three daily, and the man rapidly in creased in weight. He was discharged cured after four weeks. At that time his stools were practically normal. Twelve days after he left the hospital his colostomy wound closed spontaneously. He has a slight ventral hernia at the site of the operation. In order to avoid the occurrence of this in future cases, Dr. Bolton said he intended to employ the intramuscular incision. It was not employed in this case for fear the opening would close too promptly.

stools, mucus, hospital, weeks and cmcum