the fact that when the large intestine is affected the bowel may remain in a comparatively healthy state for weeks; and above all the actual saving of life which has now sufficiently often followed the performance of the operation to attest its undoubted value. Against the operation still stand, however, the difficulty of positive diagnosis, especially early in the disease; the speedy formation of such adhesions as will prevent reduction even after the abdomen has been opened, and the early supervention of gangrene which renders reduction improper; and the comparative frequency of spontaneous recovery by sloughing. At the present time it is admitted that in cases of acute or chronic invagination, where the diagnosis is reasonably certain, and where the means of relief which have been enumerated have been tried and failed, the abdomen should be opened. The discussion at present has changed its bearings to the question of abdominal section where the diagnosis as to the form of obstruction cannot be arrived at. The surgeon having arrived at this conclusion, no time is to be lost; for success, if the operation be successful, will depend more than anything else upon the time at which the operation is done. The operation of laparotomy or opening the abdominal cavity is to be performed as follows. The incision should be about five inches long, in the linea alba above the umbilicus. The tissues should be divided slowly and all bleeding should be stopped before the peritoneum is opened on a director to an extent equalling the opening in the skin. The seat of the obstruction is to be sought for by first noticing the condition of the caecum. If this be flaccid, the obstruction is in the small intestine; if it be distended, it is in the large. If the caecum be found undistended, the hand is to be passed gradually along the small intestine, till the obstruction is encountered; if the opposite condition obtains, the ascending, transverse, and descending colon are to be successively examined. When the invagination has been found, it should be unfolded as Hutchinson suggests, rather by expressing the included portion out of its sheath from below upwards than by traction upon it from above. If the bowel should be found perforated, or gangrenous in any part so that perforation seems probable, an artificial anus is to be formed by stitching the bowel to the lowest part of the abdominal wall. <Callout type="tip" title="Tip">Always ensure thorough sterilization before performing such operations.</Callout> If the obstruction is found to be due to a polypus, it should be removed as soon as possible. Polyps may be soft or hard; the former are composed of an hypertrophy of the villi and have a shaggy surface, while the latter consist primarily of submucous connective tissue and resemble uterine fibroids. Both types can cause haemorrhage and discharge from the rectum. Symptoms include daily or intermittent bleeding, and in severe cases, a foetid discharge that may lead to secondary complications like chronic dysentery. <Callout type="warning" title="Warning">Be cautious of misdiagnosis; polyps can mimic other conditions.</Callout> Diagnosis is often straightforward but requires careful examination and history taking. Treatment involves surgical removal, which must be done carefully to avoid injury or infection. <Callout type="important" title="Important">Always seek professional medical advice before attempting any surgery.</Callout>
Polypus.— Definition.— Hypertrophy of Villi.— Characteristic8.—Vilk)us Tumor. —Adenomatous Polypus.— Fibrous Polypus.— Structure; Characteristics.— Symptoms of Polypus.— Diagnosis.— Diagnosis from Malignant Disease.— Treatment.— Vegetations.— Definition.— Description. —Microscopic Appearances.— Relation to Syphilis.— Symptoms of Vegetations.— Diagnosis.— Treat- ment.— Ck>ndylomata.—Distinction between Condylomata and Vegetations.— Description— Syphilitic and Non-syphilitic Condylomata.— Benign Fungus. —Gummata.— Rarity and Literature.— Ano-rectal Syphiloma.— Definition of Foumier, — Fibromata. — Lipomata. — Characteristics. — Enchondromata. — Cysts.- Dermoid Growths.— Characters. — Pilo-Nidal Sinus. — Hydatids.— Foetal Inclusions.- Spina Bifida.— Congenital Cysts.
Polypus. — A polypus may be defined as a benign tumor composed of one or more of the normal elements of the wall of the rectum; an hypertrophy either of the mucous membrane or of the submucous connective tissue. Those which are composed of the elements of the mucous membrane are known and generally spoken of as 'soft' polypi; while those into which the submucous connective tissue enters are known as the 'hard' or fibrous. In many works the former class are spoken of as the polypi of childhood and the latter as those of adult age— a classification of little practical value.
Villous polypus (granular papilloma, Gosselin; villoas tumor, Cur- ling; villiBtuous polypi, Esmarch; 'peculiar bleeding tumor,' Quain). — Fig. 41 and 43. It is a question whether this form of growth should be classified with the polypi already described, or with the warty growths, whose description is to follow. It consists of an hypertrophy both of the villi and of the follicles of Lieberkuhn, with a centre of connective tissue and generous vascular supply.
Adenomatous polypus (Fig. 44). These may be due either to an hypertrophy of the follicles of Lieber- kahn or to an hypertrophy of the closed follicles. They occur most frequently in young persons; are generally of the size of a small plum, rarely reach that of a pear, and yet Esmarch reports one weighing four pounds.
Hard or fibrous polypus (sarcomatous polypus, Esmarch) which is composed primarily of the elements of the submucous connective tissue, is much rarer than the soft variety, and is most commonly found in adults, where it may be isolated or multiple. It is chiefly composed of fibrous tissue, and resembles the uterine fibroid; but it may contain both muscular and glandular elements.
Symptoms. — A rectal polypus may exist for many years, and give no sign of its presence. The two chief symptoms which it is apt to excite are haemorrhage and discharge. The haemorrhage may be a daily occurrence, or may be present only at long intervals, and it may vary in amount from a few drops to a quantity which shall cause grave disturbance and alarm.
Treatment. — The treatment of polypi is generally a simple matter. There are two dangers to be considered; the first is that the pedicle, when a pedicle exists, many contain large Teasels; the other is that it may con- tain peritoneum. The extirpation of a polypus, which has come down from its attachment in the sigmoid flexure, has beea followed by death from wounding the peritoneum, at the hands of no less a surgeon thm Broca.
Vegetations (Fig. 45). These growths, known also by the name of 'vegetations,' are composed of an hypertrophy of the submucous connective tissue and resemble the uterine fibroid; but they may contain both muscular and glandular elements. When seen in the rectum before removal, the surface is red from their vascularity, but after removal, they are pale, and generally smooth, though sometimes uneven and irregular in surface, and covered with hypertrophied papillae.
<Callout type="tip" title="Tip">Always ensure thorough sterilization before performing such operations.</Callout>
<Callout type="warning" title="Warning">Be cautious of misdiagnosis; polyps can mimic other conditions.</Callout>
<Callout type="important" title="Important">Always seek professional medical advice before attempting any surgery.</Callout>
Key Takeaways
- Rectal polyps can be life-threatening if left untreated.
- Early diagnosis and surgical intervention are crucial for successful treatment.
- Polyp removal requires careful sterilization to prevent infection.
Practical Tips
- Always ensure thorough sterilization before performing any surgery, especially in a survival scenario where medical supplies may be limited.
- Be cautious of misdiagnosis; polyps can mimic other conditions and cause similar symptoms.
- Seek professional medical advice if possible, even in a survival situation, to avoid complications.
Warnings & Risks
- Misdiagnosis can lead to improper treatment or failure to treat the condition properly.
- Inadequate sterilization during surgery can result in severe infections.
- Ignoring early symptoms of rectal polyps can lead to life-threatening complications.
Modern Application
While historical surgical techniques for treating rectal polyps have evolved significantly, understanding these conditions and their potential severity is still crucial. Modern survival medicine emphasizes the importance of recognizing symptoms early and seeking professional medical advice when possible, even in remote or resource-limited environments.
Frequently Asked Questions
Q: What are the main types of rectal polyps mentioned in this chapter?
The chapter mentions two main types of rectal polyps: soft polyps, which are composed of an hypertrophy of the villi and have a shaggy surface; and hard or fibrous polyps, which consist primarily of submucous connective tissue and resemble uterine fibroids.
Q: What are the symptoms of rectal polyps that should be monitored?
The chapter states that the two chief symptoms of rectal polyps are haemorrhage (which may be daily or intermittent) and discharge. These can vary in amount from a few drops to a large quantity, and sometimes cause grave disturbance.
Q: What is the recommended treatment for rectal polyps?
The chapter recommends that the treatment of polypi involves their extirpation as soon as possible. The operation must be performed carefully to avoid injury or infection, especially if a pedicle exists, which may contain large Teasels or peritoneum.