Abortion in Brucella abortus Fever
A loop of ileum was brought entirely outside the abdomen in order to ensure complete drainage and it was unnecessary to divide the respective mesenteries; the ends of the gut were just apposed to each other and anastomosed.
Abstract
made, and the loop proximal to the strangulation identified. This was brought outside the abdomen on the left side, at its nearest point to the strangulation but without any undue tension. No further manipulation was carried out, and the abdomen was closed. A Paul's tube was inserted into this loop, which was about the middle of the small intestine; it will be noted that the ileostomy was performed on the side opposite to the strangulation in order to leave room for a later operation near the site of obstruction. FuLrthermore, the loop of ileum was brought entirely outside the abdomen in order to ensure complete drainage: an ordinary ileostomy, with a catheter, would probably not have sufficed. Intravenous saline was continued, and five days after the ileostomy the patient was again brought to the theatre. Under spinal anaesthesia (light percaine) an oblique incision was made over the right iliac fossa. and the proximal and distal loops of the hernia were identified. These were clamped some three inches from tlle point of strangulation, divided, and an end-to-end anastomosis performed. The loops entering the hernial sac were closed off and oversewn. No great amount of manipulation was carried out, as the incision was immediately over the site of the anastomosis, and, further-more, it was unnecessary to divide the respective mesenteries; the ends of the gut were just apposed to each other and anastomosed. At the conclusion of the operation the wound was sealed off by clastoplast, and attention was then turned to the mass in the groin. There was now a large fluctuant abscess with a patch of gangrenous skin. The latter was cut into with scissors, and the pus allowed to drain away. No gross intervention was carried out in this wound for fear of increasing the toxaemia. Intravenous saline was continued, and three days later the patient again returned to the theatre for clostire of the ileostomy. Her general condition had greatly improved and she was well enough for a general anaesthetic. This operation entailed a further end-to-end anastomosis, as it will be remembered that a loop of ileum had been brought completely outside the abdomen in order to ensure better drainage. Saline drip was maintained for a further five days, making thirteen days in all; fluids by mouth had been allowed while the ileostomy was functioning, but these were stopped for two days after its closure. The patient improved rapidly, but the wound in the groin continued to disclharge offensive sloughs for several weeks. Eventually this wound healed completely, even though a permanent sinus was anticipated from thie lumina of the isolated piece of small bowel. The wotind where the ileostomy had been closed broke down some days after the operation, and a fistula was established. This drained for about three weeks, and then healed spontaneously. The patient was disclharged eleven weeks after the date of admission; she was very fit, and able to eat anything. All her wounds were well healed. It is now nine moniths since her discharge, and she is still in good health.