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Strangulation of the Small Intestine Caused by a Lipoma
CLINICAL ARTICLES.
STRANGULATION OF THE SMALL INTESTINE CAUSED BY A LIPOMA. By A. ROGERSON, F.R.e.V.s., London. HAVING regard to the importance of reporting cases of clinical interest, whether successful or otherwise, the following account may prove worthy of observation to some of the readers of this Journal. The patient was a brown mare about 13 years old, in good condition, used for the purpose of conveying fish from the Billingsgate market. for which work it was necessary for her to leave the stable very early in the morning. She was taken out as usual at 2 A.M. on the 13th inst., and nothing was noticed amiss until her arrival at the market, when she began to show symptoms of colic. In consequence of this the carman brought her back to the stable, which he reached about 4 A.M. The mare was at once put into a comfortable box, and a draught administered as quickly as possible. As this failed to have the desired effect, mustard was applied to the abdomen, and injections per rectum were given at intervals of half an hour in conjunction with anodyne draughts up to about breakfasttime, when the acute symptoms somewhat abated. The animal was now tympanitic; temperature 101°; the pulse accelerated in frequency, and fairly full to the touch; sweating about the flanks and other parts of the body well marked. Finding that the pain did not subside, and there being evidence of some abdominal obstruction, I followed up the previous treatment with doses of linseed oil and a 3vi aloetic ball, but this failed to effect any action of the bowels. Examination per rectum disclosed the absence of any fceces. Anodynes were repeated at intervals until the following morning (f4th in st.) about I I o'clock, when I diagnosed the symptoms as being due to a "Calculus." This opinion was confirmed by another practitioner who happened to be visiting me at the time. Finding that there was no response to the medicine, and perceiving that the mare was gradually sinking, we decided to perform the operation of" Enterotomy." Previous to casting the mare in her box, I punctured the abdomen in several places with the trocar and canula in order to reduce the distended condition of the bowels. Having cast the mare on her right side and administered chloroform, we made a longitudinal incision between the ilium and the last rib, just sufficiently large to admit of the introduction of the hand with a view of searching for the calculus. U sing the rectum as a guide, I felt along that portion of the intestine and also the single colon, where I anticipated I should discover the concretion, as in my experience this is the most common situation for such obstructions; and, this failing, I continued my search over other parts of the intestines, and was able to verify our diagnosis by feeling a large stone in the pelvic flexure of the double colon. I made an attempt to bring the stone to the external opening, with the intention of extracting it, but failed in my endeavour, owing to the weight and bulkiness of this portion of the bowel. By this time the mare had, to our great disappointment, succumbed to
CLINICAL ARTICLES.
her previously exhausted condition; consequently, we decided to further enlarge the opening in order to see the calculus in sittt. In so doing we discovered, much to our surprise, a large pedunculated tumour, the pedicle of which had led to a very complete strangulation of the bowel. The tumour itself was nearly spherical, with a diameter of about
TUMOUR referreu to in text (aftel a photograph by :Mr UOghlH). 1. The Llpoma; 2. PedIcle of the same encirc1 ing the bowel; 3. Mesentery; 4, 4. Cut ends of bowel; 5. A piere of string tied round the bowel, amI inadvertently left in position when the preparati on was being photographed.
J.JlPO:\fATOUS
4 inches. Its pedicle, which was about as thick as the little finger, had its root from the mesentery, close to the bowel, and passed completely round the intestine, through a hole in the mesentery, and under its own first part. How this remarkable condition of things was brought about I cannot imagine. That it must have been in existence for some considerable time was evident from the circular furrow in the bowel at the point where it was constricted by the pedicle. Thinking it a very exceptional case, I sent it to Professor M'Fadyean, who stated that it was a lipoma, and considered it of such interest as to be worthy of preservation in the Museum of the Royal Veterinary College. The mare had been under my supervision for the past eight years, and had only been the subject of colic on one occasion, which occurred in September 189I.
STRANGULATION OF THE SMALL INTESTINE CAUSED BY A LIPOMA. By A. ROGERSON, F.R.e.V.s., London. HAVING regard to the importance of reporting cases of clinical interest, whether successful or otherwise, the following account may prove worthy of observation to some of the readers of this Journal. The patient was a brown mare about 13 years old, in good condition, used for the purpose of conveying fish from the Billingsgate market. for which work it was necessary for her to leave the stable very early in the morning. She was taken out as usual at 2 A.M. on the 13th inst., and nothing was noticed amiss until her arrival at the market, when she began to show symptoms of colic. In consequence of this the carman brought her back to the stable, which he reached about 4 A.M. The mare was at once put into a comfortable box, and a draught administered as quickly as possible. As this failed to have the desired effect, mustard was applied to the abdomen, and injections per rectum were given at intervals of half an hour in conjunction with anodyne draughts up to about breakfasttime, when the acute symptoms somewhat abated. The animal was now tympanitic; temperature 101°; the pulse accelerated in frequency, and fairly full to the touch; sweating about the flanks and other parts of the body well marked. Finding that the pain did not subside, and there being evidence of some abdominal obstruction, I followed up the previous treatment with doses of linseed oil and a 3vi aloetic ball, but this failed to effect any action of the bowels. Examination per rectum disclosed the absence of any fceces. Anodynes were repeated at intervals until the following morning (f4th in st.) about I I o'clock, when I diagnosed the symptoms as being due to a "Calculus." This opinion was confirmed by another practitioner who happened to be visiting me at the time. Finding that there was no response to the medicine, and perceiving that the mare was gradually sinking, we decided to perform the operation of" Enterotomy." Previous to casting the mare in her box, I punctured the abdomen in several places with the trocar and canula in order to reduce the distended condition of the bowels. Having cast the mare on her right side and administered chloroform, we made a longitudinal incision between the ilium and the last rib, just sufficiently large to admit of the introduction of the hand with a view of searching for the calculus. U sing the rectum as a guide, I felt along that portion of the intestine and also the single colon, where I anticipated I should discover the concretion, as in my experience this is the most common situation for such obstructions; and, this failing, I continued my search over other parts of the intestines, and was able to verify our diagnosis by feeling a large stone in the pelvic flexure of the double colon. I made an attempt to bring the stone to the external opening, with the intention of extracting it, but failed in my endeavour, owing to the weight and bulkiness of this portion of the bowel. By this time the mare had, to our great disappointment, succumbed to
CLINICAL ARTICLES.
her previously exhausted condition; consequently, we decided to further enlarge the opening in order to see the calculus in sittt. In so doing we discovered, much to our surprise, a large pedunculated tumour, the pedicle of which had led to a very complete strangulation of the bowel. The tumour itself was nearly spherical, with a diameter of about
TUMOUR referreu to in text (aftel a photograph by :Mr UOghlH). 1. The Llpoma; 2. PedIcle of the same encirc1 ing the bowel; 3. Mesentery; 4, 4. Cut ends of bowel; 5. A piere of string tied round the bowel, amI inadvertently left in position when the preparati on was being photographed.
J.JlPO:\fATOUS
4 inches. Its pedicle, which was about as thick as the little finger, had its root from the mesentery, close to the bowel, and passed completely round the intestine, through a hole in the mesentery, and under its own first part. How this remarkable condition of things was brought about I cannot imagine. That it must have been in existence for some considerable time was evident from the circular furrow in the bowel at the point where it was constricted by the pedicle. Thinking it a very exceptional case, I sent it to Professor M'Fadyean, who stated that it was a lipoma, and considered it of such interest as to be worthy of preservation in the Museum of the Royal Veterinary College. The mare had been under my supervision for the past eight years, and had only been the subject of colic on one occasion, which occurred in September 189I.