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The double colon is the largest division of the intestines. It is about twelve feet in length and has a capacity of about eighteen gallons. This portion of the intestine terminates in the region of the left flank in the floating colon. The latter is about ten feet in length and about twice the diameter of the small intestine, from which it can readily be distinguished by its sacculated walls.
#Thoracic Aneurysm.# All varieties of aneurysm occur in the aorta, the fusiform being the most common, although a sacculated aneurysm frequently springs from a fusiform dilatation. The clinical features depend chiefly on the direction in which the aneurysm enlarges, and are not always well marked even when the sac is of considerable size.
#Clinical Features of Aneurysm.# Surgically, the sacculated is by far the most important variety. The outstanding feature is the existence in the line of an artery of a globular swelling, which pulsates. The pulsation is of an expansile character, which is detected by observing that when both hands are placed over the swelling they are separated with each beat of the heart.
This method is suitable to sacculated aneurysm of the limbs, so long as they are circumscribed and free from complications. It has been successfully practised also in aneurysm of the subclavian, carotid, and external iliac arteries. It is not applicable to cases in which there is such a degree of atheroma as would interfere with the successful ligation of the artery.
The aneurysm is usually of the sacculated variety, and may spring from the front or from the back of the vessel. It may exert pressure on the bones and ligaments of the joint, and it has been known to rupture into the articulation. The pain, stiffness, and effusion into the joint which accompany these changes often lead to an erroneous diagnosis of joint disease.
A traumatic aneurysm is almost always sacculated, and, so long as it remains circumscribed, has the same characters as a pathological sacculated aneurysm, with the addition that there is a scar in the overlying skin. A traumatic aneurysm is liable to become diffuse a change which, although attended with considerable risk of gangrene, has sometimes been the means of bringing about a cure.
#Sacculated Aneurysm.# When a limited area of the vessel wall is weakened for example by atheroma or by other form of arteritis this portion yields before the pressure of the blood, and a sacculated aneurysm results.
Sacculated aneurysm, as compared with the fusiform variety, tends to rupture and also to cure by the formation of laminated clot; natural cure is sometimes all but complete when extension and rupture occur and cause death. An aneurysm is said to be diffused when the sac ruptures and the blood escapes into the cellular tissue.
The Moore-Corradi method has been successfully employed, access to the sac having been obtained by opening the abdomen. Ligation of the aorta has so far been unsuccessful, but in one case operated upon by Keen the patient survived forty-eight days. #Innominate aneurysm# may be of the fusiform or of the sacculated variety, and is frequently associated with pouching of the aorta.
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