VOLVULUS OF THE JEJUNUM

CHARLES L. SCUDDER
1905 Annals of Surgery  
Surgeon to the Massachusetts General Hospital. Miss M. W., an adult, had had dyspepsia for several years; otherwise her health had heen good. After eating a boiled din¬ ner of cabbage, corned beef, and potatoes, sbe bad severe " cramps" in the abdomen. These " cramps" resembled " colicky pains." Moving about in the bed and doubling berself over--that is, drawing her knees up to her abdomen-seemed to temporarily afford relief, but the colicky, crampy pains continued. These colicky, crampy pains
more » ... icky, crampy pains were intermittent, casing up a little and then recurring with renewed force. She vomited, she bad ex¬ treme nausea, she had many loose movements from the bowel. None of these movements contained blood. The vomiting and the " dry heaving" continued all night. I saw her upon the third day of the attack. She looked sick, she presented a peritoneal facies, her features were drawn, the angles of her mouth and ala: nasi were depressed, there was a little black vomitus on the lips and chin, the abdomen was distended, the umbilicus was flush to the level of the abdominal wall, the abdomen was tym¬ panitic throughout. No tumor could be felt. Operation discovered an almost black coil of the jejunum, about two feet long, twisted at its mesenteric attachment. ( Fig. i.) Upon untwisting this volvulus, its exact extent was determined. It was found, as is seen in the photograph, to ex¬ tend up to within about two inches of the beginning of the jejunum and thence down for two feet. (Fig. 2.) The con¬ dition of the patient precluded the possibility of further inter¬ ference. The abdomen was closed and the woman died. This case serves to illustrate the very great importance of a careful, discriminating analysis of abdominal pain. Had this case been operated at the onset of the attack, the chances of re¬ covery would have been good. The several hours' delay caused the death of the bowel, tremendous shogk to the individual, and
doi:10.1097/00000658-190502000-00003 pmid:17861596 fatcat:zoe3hyncqbegljd37233dqke24