BABE CAUSES OF CHRONIC INTUSSUSCEPTION.
THREE specimens, removed by operation from elderly men in the last six months, were exhibited.
Bemarks.-Surgical . opinion is agreed in believing that chronic intussusception in adults is the resylt of tumour growth, and in elderly adults it is so likely to be due to a malignant tumour that, until the contrary is proved, one ought to expect this as the cause. These specimens show that this rule cannot be applied with absolute confidence, so that they are of highly practical interest. The first specimen shows a polypus the size of a medium-sized pear hanging from the interior of the descending colon. It is a pedunculated, submucous lipoma. At the time of the operation there was an active, superimposed on a chronic, intestinal obstruction. An alternately hardening and relaxing tumour in the left iliac fossa with signs of obstruction made a diagnosis of chronic intussusception easy. The abdomen was opened by an oblique left lateral incision over the tumour, which was found to be caused by an irreducible intussusception of the descending into the iliac colon. Acting upon the probability that this was due to a malignant growth in the colon, a wide excision of bowel and mesentery was made. The distal extremity of the iliac colon was closed and returned to the abdomen. The proximal opening at the splenic end of the transverse colon was mobilized, brought out through the incision, drained by a Paul's tube, and fixed by sutures to the abdominal wall. Part of the iliac colon, all of the descending colon, the splenic flexure, and a corresponding area of the mesentery were excised. When the patient had been given sufficient time to recover, his abdomen was opened, and; after closure of the artificial anus, the lumen of the intestine was restored by a 'lateral anastomosis (as in Fig. 111) between the transverse and iliac colon.
The next two specimens are of even greater interest, because the mistake was made, after examining the bowel through the wound, of believing that ,a growth was present when there was none at all.
The second occurred one month after-the first, and though I had the advantage of such a recent experience, with its valuable lesson, and did my .
FIG. lll.-Lateral anastomosis.