The problem of dealing with old bowel perforations in the presence of purulent collections in the pelvic area is fraught with many perplexities. I refer particularly to the fistulous communications between the bowel and tubal or tubo-ovarian abscess sacs. Such lesions present a twofold aspect: 1, as regards the immediate risk to the patient's life from general septic peritonitis; 2, as to the likelihood of establishing a permanent fecal fistula with its external outlet through Douglas' pouch or through the abdominal wound.
In this class of cases the visceral peritoneum, for several centimeters on either side of the perforation, has usually become thickened by a deposit of plastic material and has virtually lost its identity as a serous membrane. Immediate closure of a bowel perforation with such an environment by any of the suture methods, has in the majority of cases proven disappointing. The intestinal coats are so altered as
HUNTINGTON TW. A NEW METHOD OF DEALING WITH BOWEL PERFORATIONS COMMUNICATING WITH PELVIC ABSCESSES.. JAMA. 1902;XXXVIII(12):762–763. doi:10.1001/jama.1902.62480120020001f
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