OBSTRUCTION OF THE BOWEL DUE TO A ROUND WORM IN THE APPENDIX
Journal of the American Medical Association (JAMA)
cluded that there was an obstruction of the bowels and that an operation probably would be necessary. E x a m i n a t i o n . \ p = m -\ I reached the case Saturday evening and found the patient suffering some pain, though it was not severe. Temperature had been normal each time when taken and was then normal. Pulse 120. Abdomen considerably distended. There was some tenderness, but at no particular spot. The vomiting was decidedly stercoraceous and had been so since Friday. Operation.-All
... ts to move the bowels had been unsuc¬ cessful, therefore operation was decided on. I made a median incision and found the bowels much distended, especially in the ileocecal region. On endeavoring to bring up the bowel I found it firmly bound down and the appendix wrapped around the small bowel. In the colon I detected peculiar feeling sub¬ stances which proved to be two worms. One of these was in the appendix and had wrapped itself with the appendix around a loop, of the small intestine and then the tip of the appendix had become adherent to the bowel and thus formed a constrict¬ ing band. I was unable to free the appendix until, after open¬ ing the colon, I grasped the worm and drew it out. I also removed its companion and was then able to draw up the appendix and remove it, thus releasing the bowel. The con¬ tents of the bowel, being liquid, poured out over the intestines. which were afterward washed off with a carbolic acid solution, as it was impossible lo procure sterile water. Result.-The temperature remained 98, with pulse 120, till Monday, when it went up to 99. An enema on Monday pro¬ duced a fair result. Salines began Tuesday caused large, free evacuations Wednesday. The highest temperature was 101 on Thursday. The stitches sloughed and were removed Wednes¬ day. Patient made a rapid recovery. The species of worm was the' Ascaris lumbricoid.es. Patient.-Mrs. W., aged 79, called me at 7 p. m., August 24. History.-I learned that at 10 a. m. she had applied a bella¬ donna plaster 5x7% inches over the lumbar spine. During the afternoon her face became flushed and there was a blue dis¬ coloration of the lips. She experienced difficulty in swallowing and complained of vertigo and dryness of the mouth. She had taken a dose of Paine's Celery Compound, and to this she at¬ tributed her symptoms. Examination.-There was active delirium, restlessness, rig¬ idity of the flexor muscles, carphologia, bounding pulse (102), temperature 100 F., difficult articulation and extremely dilated pupils. Treatment.-Pilocarpin nitrate, gr. ys, was given hypodermically at once, and the belladonna plaster was removed; and after an hour morphin gr. %, with pilocarpin gr. %, was given hypodermically. Result.-In an hour the patient became quieter and re¬ gained consciousness about 3 a. m., August 25. The patient, 80 years old, has suffered many years from trachoma and its following ills, among others senile entropion of the lower lid. The ptosis, the entropion and the cornea! dis¬ turbance of the left eye is of very old standing, but the right entropion of the lower lid was of recent origin and was causing such corneal opacity that the patient's ability to get about was very much curtailed; she, therefore, asked for relief. Entropion of this character has to do with the entire folding in of the lid and not to the contraction of the cartilage, and is not uncommon in elderly people not suffering from some other disease. It often seems to be due to a lack of tone in the mus¬ cles and skin about the eyes. She was not very hopeful, as one operation on the left lid proved a failure, but was anxious that something be done because of the severe pain and rapidly fail¬ ing vision. I noticed that by making traction of the skin down and outward, accompanied by massage over the lower lid, that it would remain in its proper position for some time; I was tempted to try massage, but concluded that it would Pig. 1.-Senile entropion. Dotted line shows where thread was placed. result in temporary relief only, so decided to try the following simple procedure: I double-needled a piece of heavy silk thread ; then, clamping the lid, a few drops of 4 per cent, cocain were injected into the skin; removing the clamp, one needle was inserted just be¬ low the margin of the lid, about the center, and carried down and outward slightly and as close to the cartilage as possible, passing on to the margin of the orbit, where I caught up the periosteum coming out on the skin. The other needle was in¬ serted about three millimeters away from the first entrance and carried down parallel to the first thread, passing through the periosteum and coming out near the other exit. The two ends were then tied over a piece of cotton with sufficient tension to retain the lid in position, and allowed to remain so for two days, when the loop was fished out from the skin, and every day the threads were drawn back and fourth. At the end of two weeks a heavy band of cicatricial tissue formed; the threads were then removed, the lid being held firmly in posi¬ tion. The result is well shown in the photograph. I pro¬ pose to treat the other lid in a similar manner.