Reviews

;enderness on the left side, above the level of the umbilicus. T'hinking that the condition might be due to some indiscretion in diet we'decided to watch the case. Two aays later her conflition became much worse. She had abdomin&l pain, distenSion, vomitinag, aiid her bowels had -not acted, and no flatus had been passed. She was seen on this occasion by Dr. Wrangham of Bradford, who diagnosed intestinal obstruction aind recommended immediate operation. I saw her the same eveninig (July .3rd, 1920) in a nursing home, and found the abdomen very distended and tympanitic. She was omiting, and peristalsis was plainly visible through the anterior abdominlal wall. Laparotomy was performed, and on opening the peritoneal cavity some slightly turbid fluid escaped. The junction of the distended and collapsed small intestine was quickly found, and at this poilnt a small loop of the gut was found tq enter' the paraduoden-al fossa, and obstruction was absolute. The intestiine was removed from the fossa without diffiWulty and the fossa was closed by two stitches of catgut, although there was plastic vlynph present which would probably have obliterated it witlhout the aid of stitches. As the intestine had not lost its lustre at the poinlt of obstructioni, and as a wave of peristalsis passed across the constriction, and seeing that the distended gtult contracted when stimulated with a warm towel, the abdominal wouind was closed in three layers without drainage. Subcutanieous saline was given throughout the operation. The child was bandaged in cotton-wool, and all the manipulations niecessary were carried out without delivering the gut. The operation lasted seventeen minutes. Convalescence was uneventful, there was very little shlock, and recovery lhas been complete; BASIL HUGHES, D.S.O., M.A., M.B., B.Clj.Camb., B.Sc.Lond., F.R.C.S., Assistant Honorary Surgeon, IBradford Childreu's Hospital; Stirgical Pathologist, Bradford Itoyal Infirmary.