An Address ON OPSONINS AND THEIR UTILITY IN PRACTICAL MEDICINE: Read before the Meeting of the Tunbridge Wells and Neighbouring Divisions of the British Medical Association

H. French
1907 BMJ (Clinical Research Edition)  
THE following case seems of sufficient interest to place on record, and I have not been able to find a reference t;o a similar condition. A little more than a year ago (November 9th, 1905), while operating in the loyal Infirmary on a case of right-sided acquired strangulated Inguinal hernia in a man aged 33 years, and while about to return the. congested but viable intestine, I noticed several peculiar depressions on the convexity of the loop. The amount of -bowel involved was about 9 in., and
more » ... he depressions (six in number) were situated at about equal 4istances from one another. On exploration with a probe 't was found that these depressions represented the mouths of hollow finger-like processes which projected qbliquely into the lumen of the gut for distances varying.from 1 in. (the shortest) to 2 in. (the longest). The largestprocess was of sufficient diameter just to permit the insertion of, a Kocher's dissector. All ended blindly, an.d were apparently localized invaginations of the whole thickness of the wall of the gut. The condition will best be understood if one imagines a number of slender Meckel's diverticula pulled (inside out) into the interior of the bowel. It is easier, however, to describe the condition than to suggest an explanation for it. -That these localized invaginations (?) were of recent origin, due to some irregular peristalsis of the bowel, it is impossible to believe. Their length, their number, and the absence of any constrictions in, the bowel at their sites preclude this supposition. Moreover, repeated gentle attempts in various ways to " reduce " one of them ailed. The bowel was accordingly replaced in the abdomen, leaving them exactly as they were. It is interesting, however, to note that they were apparently confined to the portion of intestine involved in the hernia, since examination of several inches of bowel above and below the strangulated loop revealed no indication of a similar condition. Further, on close inspection of the loop, certain slight thickenings of its wall, apparontly of a chronic inflammatory character, could be seen in the intervals between the openings of the diverticula. These thickenings (they could not be called bands) were situated at right angles to the long axis of the bowel. It may be mentioned, also, that a few, but not very strong, adhesions existed near the neck of the sac. Since these appearances seemed to suggest, at any rate, a causal connexion between the hernia and the diverticula, special care was taken on the patient's recovery to obtain a full history of his case. The more important points were as follows: No history obtainable of enteric fever, or indeed of any illness of any sort. Bowels have al]ways been regular. Patient first noticed the hernia as a small swelling, three years ago, which disappeared when lie lay down. He does not think it followed any strain (patient is a carpenter). The hernia gradually increased in size, and a year ago it had become scrotal and was about the size of a duck's egg. At this time towever, on one occasion he found he could not put it back, and strangulation occurred. Reduction was successfully accomplished by Dr. Miller of New Mains, under chloroform. During the past year the hernia frequently descended into the scrotum, but patient says he was always able to put it back until the present (second) attack of strangulation occurred (November 9th, 1905). On this occasion Dr. Kay of Shotts found reduction impossible, and accordingly sent him ipto hospital. At no time has patient.ever worn a truss. I have delayed publishing this case until now, as I wished to see whether the after-history might throw any further light on the condition. I saw the patient lately (December 15th, 1906), when he told me that he has been in good health since the operation and able to work. His bowels had been regular. The cicatrix is sound (radical cure was done at the time of the herniotomy). The only thing that he complains of is that for the last six months he has felt " slight aching pains " in the right inguinal region in the evenings after his work is over. HIe also volunteered the interesting information that for some four or five years before he noticed the hernia he suffered from somewhat similar pains in the same situation. These, however, were more severe than the present ones, and of a " prickling " character. It would be interesting to know whether either of these pains is associated or not with the diverticula. I am indebted to Dr. William Robertson, late House-Surgeon Edinburgh Royal Infirmary, who assisted me at the operation, for reading over the notes of this case, in the description of which he concurs.
doi:10.1136/bmj.1.2405.256-a fatcat:fep7opaitvc5nih2zaotzzqoz4