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Imperforate Rectum Dr Wharton

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IMPERFORATE RECTUM.

DR. WHARTON presented a two months' old female infant, who, when three days of age, was admitted to the Children's Hos pital, October 19, 1900, with the history that at birth the anus was normal in appearance, and it was only after twenty-four hours that it was noticed that no fecal matter escaped, that the child suffered from pain, that the belly became distended, and persistent vomiting occurred.

Upon examination he found the belly hard and distended. Examination of the anus showed that a probe or the tip of the finger could be introduced to a distance of an inch, and when the child cried it seemed that bulging of the bowel could be detected anteriorly. The anus was enlarged by an incision backward and the tissues were carefully divided, and when the in cision had reached a depth of one and three-fourths inches, a bulg ing mass, resembling the rectum, was exposed in the anterior por tion of the wound ; this was opened by a small incision, and it was found to be the vagina. A careful dissection posterior to this failed to expose the rectum. The bleeding was then arrested by sutures and packing, and a left iliac colostomy was made. Upon opening the peritoneum a large thin pus gushed from the wound, and the small intestine which presented in the wound was injected. The small intestine was displaced, and the de scending colon was brought up into the wound and sutured to its lower angle; gauze drains were next introduced from the upper portion of the wound into the peritoneal cavity for drainage. The colon was next opened and a free discharge of meconium occurred. Upon exploring the colon through the wound with the finger, it was found that the bowel terminated in a blind pouch about the region of the promontory of the sacrum.

The child improved after the operation, the vomiting ceased, and the abdominal distention disappeared. A certain amount of pus escaped by the way of the gauze drains ; they were removed on the third day, and were not replaced. The upper portion of the colostomy wound was healed in a week, and the patient had satis factory movements through the artificial anus. And now, a month after the operation, the child is taking nourishment well and is fairly well nourished.

Under the conditions presented, the case seemed to be a hope less one, and he was very much surprised upon seeing the case on the following day to find it doing well. The occurrence of a purulent peritonitis without rupture of the bowel was to him a matter of great interest in this and he regretted very much that no bacteriological examination was made of the pus which escaped from the abdominal cavity at the time of operation, to determine the nature of the infection. •

wound, anus, child and operation