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In employing torsion, the end of the vessel is caught with forceps, and the terminal portion twisted round several times. The object is to tear the inner and middle coats so that they curl up inside the lumen, while the outer fibrous coat is twisted into a cord which occludes the end of the vessel. Forci-pressure.
#Prognosis.# When natural cure occurs it is usually brought about by the formation of laminated clot, which gradually increases in amount till it fills the sac. Sometimes a portion of the clot in the sac is separated and becomes impacted as an embolus in the artery beyond, leading to thrombosis which first occludes the artery and then extends into the sac.
About one inch back of this is the anus, or the external orifice of the large bowel. This part of the bowel is known as the rectum. The Hymen. The hymen consists of a thin duplicature of mucous membrane strengthened by fibrous tissue, and is stretched across the posterior part of the vaginal orifice, which it partly occludes.
The internal clot plays the most important part in the process; it becomes invaded by leucocytes and proliferating endothelial and connective-tissue cells, and new blood vessels permeate the mass, which is thus converted into granulation tissue. This is ultimately replaced by fibrous tissue, which permanently occludes the end of the vessel.
An internal clot forms and, becoming organised, permanently occludes the vessel as above described. The ligature and the small portion of vessel beyond it are subsequently absorbed.
Like incomplete rupture, this lesion is accompanied by loss of pulsation and power, and by coldness of the limb beyond; a tense and excessively painful swelling rapidly appears in the region of the injury, and, where the cellular tissue is loose, may attain a considerable size. The pressure of the effused blood occludes the veins and leads to congestion and œdema of the limb beyond.
The actual cautery or Paquelin's thermo-cautery is seldom employed to arrest hæmorrhage, but is frequently useful in preventing it, as, for example, in the removal of piles, or in opening the bowel in colostomy. It is used at a dull-red heat, which sears the divided ends of the vessel and so occludes the lumen. A bright-red or a white heat cuts the vessel across without occluding it.
The bruising of the vessel wall, especially if it is diseased, may result in the formation of a thrombus which occludes the lumen temporarily or even permanently, and in rare cases may lead to gangrene of the limb beyond. #Subcutaneous Rupture.# An artery may be ruptured subcutaneously by a blow or crush, or by a displaced fragment of bone.
The middle coat contracts and retracts, and the internal, because of its elasticity, curls up in the interior of the vessel, forming a valvular obstruction to the blood-flow. In most cases this results in the formation of a thrombus which occludes the vessel. In some cases the blood-pressure gradually distends the injured segment of the vessel wall and leads to the formation of an aneurysm.
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