Complete and Permanent Re- 
covery by Jejuno-Ileostomy 
with Senn's Bone Plates 
In Intestinal Obstruction due to Intus- 
susception and Sloughing of the 
In tussusceptum. 
by 
THOMAS H. RUSSELL, M. D., 
PROFESSOR OF MATERIA MEDICA AND THERAPEUTICS, 
YALE UNIVERSITY, AND SURGEON TO THE CON- 
NECTICUT STATE HOSPITAL. 
REPRINTSD FROM 
Siljt Neto STorfc fUettic&l Soiunal 
for December 20, 1890. Reprinted from, the New York Medical Journal 
for December 20, 1890. 
COMPLETE AND PERMANENT RECOVERY BY 
JEJUNO-ILEOSTOMY WITH SENN'S BONE PLATES 
IN INTESTINAL OBSTRUCTION DUE TO 
INTUSSUSCEPTION AND SLOUGHING OF THE INTUSSUSCEPTUM. 
By THOMAS H. RUSSELL, M. D., 
PROFESSOR OF MATERIA MEDICA AND THERAPEUTICS, YALE UNIVERSITY, 
AND SURGEON TO THE CONNECTICUT STATE HOSPITAL. 
On August 16, 1889, I was summoned to visit a boy, 
fifteen years of age, living on a farm in Montville, Conn. I 
found that he was suffering from very severe chronic ob- 
struction (stenosis) of the small intestine. 
The history of the case was as follows : 
Until October 2, 1888, he had been strong and in perfect 
health, but on that day, while wrestling, was attacked by an 
extremely acute pain in his abdomen, quickly followed by severe 
vomiting and obstinate constipation, which persisted for five 
days. On the fifth or sixth day his bowels were moved, and the 
vomiting became less severe. During the next few weeks the 
emesis was less frequent, the pain became intermittent, although 
severe, and the constipation gradually changed to diarrhoea. 
On November 1st (or soon after) a soft, fleshy mass was no- 
ticed in one of his stools. 
During the ten months preceding my visit and operation he 
had been under the care of Dr. Smith and Dr. Bishop, of Nor- 
wich, Dr. Matthewson, of Montville, and others. 2 
COMPLETE AND PERMANENT RECOVERY BY 
During these ten months he was confined to bed much of 
the time, and there were occasional attacks of vomiting and 
from three to seven light-colored liquid stools daily, but free 
from blood. The abdomen was much distended and tympa- 
nitic; his appetite was poor and his tongue coated. 
He became much emaciated and had night sweats, but no 
elevation of temperature. During these ten months he suffered 
from severe attacks of abdominal pain, recurring about every 
twenty to forty minutes night and day, and lasting from three 
to five minutes. Each of these attacks of pain was preceded 
or accompanied by such violent intestinal peristalsis that the 
contour of the intestine formed very prominent visible ridges 
in the abdominal wall. 
In each attack the severe pain commenced after the violent 
peristalsis had lasted one or two minutes, and disappeared sud- 
denly when, three to five minutes later, there was a loud sound 
as of gas and liquid being forced through a small orifice. Im- 
mediately afterward the pain and peristalsis would cease, and 
the patient become comfortable. 
The pain was sometimes above the umbilicus and at other 
times below or to the right or left, and not confined to any 
one point. All his symptoms were gradually becoming more 
severe. During my visit on August 16, 1889, I was able to ob- 
serve a number of these attacks, and it appeared probable (as 
the laparotomy next day proved true) that they were due to 
nearly complete obstruction in the small intestine. The regu- 
larly recurring, violent, and painful peristalsis was the effort 
of the intestine to force its contents through a very small aper- 
ture. Laparotomy being indicated, I operated on the follow- 
ing day (August 17, 1889), assisted by Dr. Smith, of Norwich, 
Dr. Matthewson, of Montville, and Dr. R. S. Bradley, of New 
Haven. 
The incision extended from the umbilicus to the pubes. I 
found it impossible to locate the obstruction without removing 
the small intestines from the abdomen, and, while doing so, 
protected them with napkins wrung out of hot Thiersch's solu- 
tion. The obstruction was found at a point near the junction 
of the upper and middle thirds of the small intestine. JEJUNO-ILEOSTOMY WITH SENN'S BONE PLATES. 
3 
As shown in the accompanying illustration, the small intes- 
tine, 6 to c, was so extremely contracted at a that its diameter 
was only about a quaiter of an inch, and at that point it was 
firmly bound down by a strong old band of adhesion, a, to the 
wall of an adjacent loop of intestine, d. 
All of the portion of intestine 5 above the obstruction a 
was distended to about three times its normal caliber and 
filled with gas and liquid faeces. All of the portion of in- 
testine c below the obstruction was empty, contracted, and 
flaccid. 
The obstruction was evidently an old one, and it was plainly 
impossible to restore the caliber of the bowel at that point. 
The best plan was evidently to establish an intestinal anasto- 
mosis, as suggested by Professor Senn. After locating the 
obstruction, it was found impossible to return the rest of the 
intestine into the abdomen, owing to its distention above the 
obstruction. 
I therefore made a linear incision, an inch and a half long, 
at k above the obstruction, and emptied all of the contents 
of the bowel, consisting of about a quart of yellow liquid faeces 
and a large amount of gas, into a pan. The intestine was then COMPLETE AND PERMANENT RECOVERY BY 
4 
easily replaced within the abdomen. A Senn's perforated de- 
calcified-bone plate was then introduced through the incision 
in the bowel at and another bone plate was introduced 
below the obstruction through an incision at p. The bone 
plates were approximated after scarifying the serous surfaces, 
and about twelve Lembert sutures were introduced around the 
circumference of the plates. The intestine was then cleansed 
and the abdomen flushed with hot Thiersch's solution, and the 
abdomen closed. 
His recovery was rapid, perfect, and permanent. Although 
his temperature was taken every two to four hours for eight 
days, it only once went above normal, and then only tran- 
siently touched 100'2° on the second day. I did not visit him 
after the sixth day, the nurse was discharged on the eighth, 
the patient sat up about the tenth, and was down stairs 
about the sixteenth or eighteenth day. Dr. Smith made a 
few visits afterward. The patient had a large normal stool 
five days after the operation, and his bo'wels moved regularly 
afterward. All stools were examined for traces of the bone 
plates. Nine days after the operation the remains of a bone 
plate (probably the distal one) were found in one of the stools. 
It was of only about a quarter of the thickness, half of the 
width, and two thirds of the length of the original plate, and 
was so soft as to require careful handling. A few days later, 
barely perceptible remnants of the other plate were evacuated, 
and none subsequently. From that time he quickly and steadi- 
ly improved in health in every respect, and resumed his work 
on the farm. It is now fifteen months since the operation, and 
he is in every way enjoying good health. 
The boy is strong and able to do ordinary work. There is 
every indication that his recovery is absolutely complete and 
permanent. I believe that this is the most successful case of 
the kind thus far on record. It seems evident that the com- 
mencement of his disease on October 2, 1888, was an intussus- 
ception (at point a in the diagram), that the soft, fleshy mass 
passed in one of his stools about a month later was the intus- 
susceptum, which had sloughed out, and that the subsequent 
stenosis and adhesions were results of that process. JEJUNO-ILEOSTOMY WITH SENN'S BONE PLATES. 
5 
My experience in this case and in another, in which I 
performed gastro-enterostomy with decalcified-bone plates 
for cancerous stenosis of the pylorus, convinces me that the 
bone plates are much to be preferred to the various catgut 
substitutes (rings and mats) and all other substitutes which 
have been suggested. They are admirably adapted for the 
purpose and need no improvement.