File:Surgery, its principles and practice (1906) (14586608399).jpg

Identifier: surgeryitsprinci04keen (find matches)
Title: Surgery, its principles and practice
Year: 1906 (1900s)
Authors: Keen, William W. (William Williams), b. 1837 Da Costa, J. Chalmers (John Chalmers), 1863-1933, joint ed
Subjects: Surgery General Surgery
Publisher: Philadelphia and London : W. B. Saunders
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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Some one of thesedefects occurs in aboutone in eight or tenthousand births (Figs.81 to 88). It is very commonfor this defect to beoverlooked at birth,especially if the analdimple appears nor-mal; and the earlyevidences of troubleare only noticed by theabsence of the usualdischarge of mecon-ium, or an unusuallyfull appearance of thechilds abdomen, withrestless manner. Thedistention may notoccur for two or threedays, as there is littlewind formed in theintestines, owing tothe infant being alwaysborn with bacteria-freecontents of the bowel,contaminated later byfood or anal infection. Children born in this condition do not usually survive many days;restlessness, distention, and an inaptitude for food wearing out the vitalityof the infant. Some children live, however, for several weeks. If notoperated upon, the distention may increase to large proportions. If the occlusion is incomplete, the symptoms may be less urgent,depending on the degree of occlusion, and rare cases have even gone on
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Fig. 89.—Malformation op Anus.Enterodeum (hind-gut) continued as a tapering tortuoustube (a) along the raphe of the scrotum, and ending by a minuteopening (6) discharging meconium near the end of the penis;c, anal depression—imperforate (International Text-book ofSurgery). 120 SURGERY OF THE RECTUM AND ANUS. to adult life, passing feces and urine through the bladder, urethra, vagina,or through a very contracted rectum or anus. Prognosis naturally depends on the form of occlusion. It is goodwhen there is simply a membranous diaphragm between the rectum andthe anal dimple; or when the rectum opens freely into the A^agina. In all operative forms the mortality is high. Crippss table of 100cases gives 50 per cent, mortality. 16 cases colon opened in the groin 11 died 3 cases colon opened in the loin 2 17 punctured from below 14 8 coccyx resected 5 37 perineal dissection and incision 14 14 communicated with the vagina 1 3 miscellaneous _ • 3 50 died

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