Two Rare Cases of Internal Strangulation

Abstract

It would appear that an individual subsisting on the unsupplemented diet, as provided at the Hope Bay base, passes gradually into the subscorbutic state over a period of about 12 weeks. This is about the time taken for a saturated individual to develop scorbutic manifestations when completely deprived of ascorbic acid. In the absence of more accurate methods for the determination of the ascorbic acid content of the diet at the base, this time-lag suggests that the vitamin is present in negligible quantities or entirely lacking in the food provided. The importance of all personnel taking a regular ration of ascorbic acid cannot be over-emphasized.At Hope Bay it was found that cuts and abrasions, particularly on the fingers, though more painful than in temperate climates did not take longer to heal. It seems reasonable that the delay in healing of such minor wounds observed by Pirie and his companions was due not to a diminished blood supply in low temperatures, as he thought, but to a deficiency of vitamin C. Two Rare Cases of Initernal StrangulationInternal strangulation is not a common type of intestinal obstruction. During my year of office as resident surgical officer at the Royal Victoria Infirmary, Newcastle-uponTyne, 55 cases of intestinal obstruction were operated upon and only five of these were internal strangulations, all of them volvuli. Four involved the small intestine and one the large intestine. Other volvuli of the large intestine were seen, but in none was the blood supply to the bowel in danger. Internal strangulation without volvulus is probably the cause of obstruction in less than 2% of cases and is associated with adhesions or internal herniation.The following two cases are of interest both for their rarity and for the clinical signs with which they presented. CASE 1The patient, a man aged 20, was admitted on January 21, 1947, with a diagnosis of pelvic abscess due to acute appendicitis. This diagnosis was accepted and he was treated conservatively.When seen on January 22 his condition was deteriorating. He gave a history of sudden onset of severe abdominal pain and he had vomited five or six times before admission. His vomiting was persistent and was associated with colicky pain and absolute constipation. It seemed certain from this history that he was suffering from acute intestinal obstruction.On examination, however, the physical signs were most misleading. He looked ill; his pulse was 90 and his temperature 99.6°F. (37.550 C.). There was lower abdominal tenderness and rigidity, and rectal examination revealed a large tender mass in the rectovesical pouch, closely simulating a pelvic abscess. However, in view of the history and the obvious deterioration in the patient's condition, it was decided to perform a laparotomy. Pre-operative glucose-saline and gastric aspiration were started.The operation was performed under spinal analgesia administered by Dr. E. I. Tate. A right paramedian incision was made, and when the peritoneum was opened there was an escape of foul-smelling blood-staine...

Transepiploic hernia

“…Surgical Pathology.-The site of the hiatus is usually midway along the omentum, in most cases near the free edge, though the aperture in the case of Hindmarsh (1949) was situated at the base of the omentum. T h e lateral margins are often the omental blood-vessels.…”