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Congenital absence of continuity between small and large intestine, with abnormal blood-supply of the proximal colon

Congenital absence of continuity between small and large intestine, with abnormal blood-supply of... 540 THE BRITISH JOURNAL OF SURGERY SUMMARY Thanks are due to the County Medical Officer Dr* ponder, and the Superintendent, I. A case is described of strangulated obturator hernia containing the Fallopian tube. Dr. Hackwood, for permission to publish the case* 2. A pre-operative diagnosis could have been made on the available history, symptoms, and __-__-_____ - ~ --- - - -- signs. REFERENCE 3. Stress has been laid on the value of the Howship-Rombergsign in the diagnosis of strangu- WATSON, LEIGH F. (1938), Hernia. London : Hcnry lated and non-strangulated obturator hernia. Kimpton. CONGENITAL ABSENCE OF CONTINUITY BETWEEN SMALL AND LARGE INTESTINE, WITH ABNORMAL BLOOD-SUPPLY OF THE PROXIMAL COLON BY HERBERT HAXTON FROM THE DEPARTMENT OF SURGERY, RADCLIFFE INFIRMARY, OXFORU and the intestine was twisted round a peritoneal fold DEVELOPMENTAL anomalies of the intestines are which enclosed the superior mesenteric artery. The not very rare, but no record has been found of a twist was particularly tight just proximal to the case similar to the one presented here. terminal sac, which looked and felt to be infarcted, a finding later confirmed by histological section. The CASE REPORT volvulus was undone, the sac excised, and the end of A male infant, 2 days old, had a history of repeated the small intestine brought through the abdominal vomiting since birth, no feeds being retained. No wound, which was closed around it in layers with meconium had been passed. The baby was full- nylon sutures. The infant’s condition deteriorated time and well-nourished, with no external signs of and despite rescuscitative measures he died on the following day. AT AuTorsY.-The terminal inch of the small intestine was infarcted. The colon was complete in form, but diminutive and lying in the lower abdomen and pelvis, stuck to the posterior abdominal wall. The tiny caecum had an appendix, and just above it was the terminal ileum represented by a small diverti- culum of the colon. The blood-supply of the colon was derived from two arteries, both springing direct from the aorta, of which the upper supplied the right half of the colon. The venous drainage was by a normal inferior mesenteric vein to the splenic vein. (Fig. 484.) DISCUSSION The normal pattern for the arterial supply of the intestines is that the mid-gut (duodenum to left side of transverse colon) is supplied by the superior mesenteric artery, and the hind-gut (transverse colon to rectum) by the inferior mesenteric artery. In this case, those branches which normally arise from the right side of the superior mesenteric artery, ileocolic, right colic, and mid-colic arteries, arose from a separate branch of the aorta, and the corresponding venous drainage accompanied that of the hind-gut. FIG. 484.-The blood-supply to the colon and small intestine. This abnormal blood-supply was possibly respon- sible for the breach of continuity in the intestinal abnormality except for a distended and tense abdomen. tract, since it rendered the whole colon independent A finger passed into the rectum without difficulty, of the small intestine. The extensive fixation of but the upper rectum felt narrow. Under the dia- the colon seemed to indicate that it had not gnosis of congenital intestinal obstruction the abdomen shared in the mid-gut protrusion into the extra- was opened under local infiltration anaesthesia. embryonic celom and the subsequent rotation The small intestine, grossly distended and con- gested, ended in a blind piriform sac. There was no which normally takes place in the 6th to 12th mesenteric fixation to the posterior abdominal wall, weeks of fetal life. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png British Journal of Surgery Oxford University Press

Congenital absence of continuity between small and large intestine, with abnormal blood-supply of the proximal colon

Haxton, Herbert
British Journal of Surgery , Volume 32 (128): 1 – Apr 1, 1945
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Publisher
Oxford University Press
Copyright
Copyright © 1945 British Journal of Surgery Society Ltd.
ISSN
0007-1323
eISSN
1365-2168
DOI
10.1002/bjs.18003212833
Publisher site
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Abstract

540 THE BRITISH JOURNAL OF SURGERY SUMMARY Thanks are due to the County Medical Officer Dr* ponder, and the Superintendent, I. A case is described of strangulated obturator hernia containing the Fallopian tube. Dr. Hackwood, for permission to publish the case* 2. A pre-operative diagnosis could have been made on the available history, symptoms, and __-__-_____ - ~ --- - - -- signs. REFERENCE 3. Stress has been laid on the value of the Howship-Rombergsign in the diagnosis of strangu- WATSON, LEIGH F. (1938), Hernia. London : Hcnry lated and non-strangulated obturator hernia. Kimpton. CONGENITAL ABSENCE OF CONTINUITY BETWEEN SMALL AND LARGE INTESTINE, WITH ABNORMAL BLOOD-SUPPLY OF THE PROXIMAL COLON BY HERBERT HAXTON FROM THE DEPARTMENT OF SURGERY, RADCLIFFE INFIRMARY, OXFORU and the intestine was twisted round a peritoneal fold DEVELOPMENTAL anomalies of the intestines are which enclosed the superior mesenteric artery. The not very rare, but no record has been found of a twist was particularly tight just proximal to the case similar to the one presented here. terminal sac, which looked and felt to be infarcted, a finding later confirmed by histological section. The CASE REPORT volvulus was undone, the sac excised, and the end of A male infant, 2 days old, had a history of repeated the small intestine brought through the abdominal vomiting since birth, no feeds being retained. No wound, which was closed around it in layers with meconium had been passed. The baby was full- nylon sutures. The infant’s condition deteriorated time and well-nourished, with no external signs of and despite rescuscitative measures he died on the following day. AT AuTorsY.-The terminal inch of the small intestine was infarcted. The colon was complete in form, but diminutive and lying in the lower abdomen and pelvis, stuck to the posterior abdominal wall. The tiny caecum had an appendix, and just above it was the terminal ileum represented by a small diverti- culum of the colon. The blood-supply of the colon was derived from two arteries, both springing direct from the aorta, of which the upper supplied the right half of the colon. The venous drainage was by a normal inferior mesenteric vein to the splenic vein. (Fig. 484.) DISCUSSION The normal pattern for the arterial supply of the intestines is that the mid-gut (duodenum to left side of transverse colon) is supplied by the superior mesenteric artery, and the hind-gut (transverse colon to rectum) by the inferior mesenteric artery. In this case, those branches which normally arise from the right side of the superior mesenteric artery, ileocolic, right colic, and mid-colic arteries, arose from a separate branch of the aorta, and the corresponding venous drainage accompanied that of the hind-gut. FIG. 484.-The blood-supply to the colon and small intestine. This abnormal blood-supply was possibly respon- sible for the breach of continuity in the intestinal abnormality except for a distended and tense abdomen. tract, since it rendered the whole colon independent A finger passed into the rectum without difficulty, of the small intestine. The extensive fixation of but the upper rectum felt narrow. Under the dia- the colon seemed to indicate that it had not gnosis of congenital intestinal obstruction the abdomen shared in the mid-gut protrusion into the extra- was opened under local infiltration anaesthesia. embryonic celom and the subsequent rotation The small intestine, grossly distended and con- gested, ended in a blind piriform sac. There was no which normally takes place in the 6th to 12th mesenteric fixation to the posterior abdominal wall, weeks of fetal life.

Journal

British Journal of Surgery – Oxford University Press

Published: Apr 1, 1945

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