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Through the wound protruded the greater part of the larger curvature of the stomach; the arch of the colon and the entire greater omentum were both strangulated. A small portion of the coats of the stomach, including the wound, was nipped up, a silk ligature tied about it, and the entrails replaced.
It may be caused also, by the not flowing or over-flowing of the courses by swellings, ulcers, and inflammation of the womb, by an excrescence of flesh growing about the mouth of the matrix, by the mouth of the matrix being turned up to the back or side by the fatness of the body, whereby the mouth of the matrix is closed up, being pressed with the omentum or caul, and the matter of the seed is turned to fat; if she be a lean and dry body, and though she do conceive, yet the fruit of her body will wither before it come to perfection, for want of nourishment.
Matas suggests infolding the wall of the vessel with interrupted sutures that do not pierce the intima, and wrapping it round with a strip of peritoneum or omentum. The most serious form of arterial thrombosis is that met with in the abdominal aorta, which is attended with violent pains in the lower limbs, rapidly followed by paralysis and arrest of the circulation.
The patient's resistance was used up and, being exhausted he died. "Autopsy: Normal condition of the scrosa above the omentum: the appendix surrounded by adhesions embedded in fecal pus? gangrenous toward its terminal portion, and showing perforation; fecal calculus in the pus; appendix movable toward the cecum."
He swallowed dirt, clay, pebbles, and glass, and was addicted to intoxication by brandy. He lived sixty years in this manner and then he became abstemious; he died at seventy-nine. His omentum was very lean, but the liver covered all his abdominal viscera. His stomach was very large and thick, but the intestines were very narrow.
Bausch mentions a case in which the omentum, stomach, and pancreas were found in the thoracic cavity, having protruded through an extensive opening in the diaphragm. Muys, Bonnet, Blancard, Schenck, Sennert, Fantoni, and Godefroy record instances in which, after rupture of the diaphragm, the viscera have been found in the thorax; there are many modern cases on record.
Rein speaks of the removal of an enormous echinococcus cyst of the omentum without interruption of pregnancy. Robson reports a multi-locular cyst of the ovary with extensive adhesions of the uterus, removed at the tenth week of pregnancy and ovariotomy performed without any interruption of the ordinary course of labor.
Portions of fat are often obtainable at operations from the omentum, for example, otherwise the subcutaneous fat of the buttock is the most accessible; it may be employed to fill up cavities of all kinds in order to obtain more rapid and sounder healing and also to remedy deformity, as in filling up a depression in the cheek or forehead.
Wetmore of Illinois saw a woman who in the summer of 1860, when about six months pregnant, was gored by a cow, and the large intestine and the omentum protruded through the wound. Three hours after the injury she was found swathed in rags wet with a compound solution of whiskey and camphor, with a decoction of tobacco. The intestines were cold to the touch and dirty, but were washed and replaced.
And ever and anon the master turned to his book, as he laid bare the mysteries of the hidden organs; to his precious Vesalius, it might be, or his figures repeated in the multifarious volume of Ambroise Pare; to the Aldine octavo in which Fallopius recorded his fresh observations; or that giant folio of Spigelius just issued from the press of Amsterdam, in which lovely ladies display their viscera with a coquettish grace implying that it is rather a pleasure than otherwise to show the lace-like omentum, and hold up their appendices epiploicae as if they were saying "these are our jewels."
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