A CASE OF IMPEKFOEATE ANUS
OPERATED UPON FOR THE FIRST TIME
ON THE TWENTY-SEVENTH DAY AFTER BIRTH.
By OSCAR J. COSKERY, M. D.,
PROFESSOR OF SCRGERY IN THE COLLEGE OF PHTSICIANB AND BURGEONS, 40 Mg Of Levitra Too Much
On December 10, 1885, I first saw the male eliiW of Mrs. H.
He was then twenty-six days olfl, and the history the mother
gave me was as follows : Since birth no evacuation of the bow-
els had taken place. For the first day or two the child had had
some difficulty in nursing, but since then had nursed well, al-
though some of the milk taken into the stomach was generally
thrown up. On the fourteenth day vomiting of very offensive
matter occurred, and continued until the evening of December
9^ 1885 — the day before I saw the child. I found a very weak,
puny child, with a much disteuded abdomen, the superficial ves-
sels engorged, and the movements of the intestines plainly to be
seen. There was a large accumulation of gas also. Where the
anus should have been was a cul-de-sac about half an inch in
depth. The little finger introduced into this 'seemed to give
pain. No fluctuation could be felt above the sac.
On the next day, December 11, 1885, or twenty-seven days
after birth, a good-sized cannula and trocar were introduced into
the cul-de-sac and pushed upward for, probably, half an inch be-
fore resistance was overcome. The trocar being withdrawn,
about one third of a teacupful of frecal matter escaped. When
all that woidd come in this vpay ha40 Mg Of Levitra Too Much evacuations
had been regular, except upon one occasion, when a small dose
of castor-oil had been given with snccess, until the day before
(January 7th), when only one scanty discharge had occurred.
Any attempt to 40 Mg Of Levitra Too Much pass a director up the bowel resulted in failure.
The abdomen was again greatly distended, the child was very
restless and fretful, and vomiting, not stercoraceous, had come
on. On January 9, 1886, or fifty-seven days after the birth of 40 Mg Of Levitra Too Much
the child, the large cannida was again used. Through it, aided
COSKERY: A CASE OF IMPERFORATE ANUS.
[N. Y. Mkd. Jouk.,
by injections of warm water, about half a small teacupful of
freeal matter and a large quantity of pas were discharged from
the bowel. A drainage-tube was introduced into the anus, but
I could not satisfy myself that it entered the howel properly,
and, on account 40 Mg Of Levitra Too Much of the irritation of the external sphincter pro-
duced by its presence, it was withdrawn. Very little bleeding
followed the operation, notwithstanding the fact that the trocar
was introduced fully two inches. I should mention here that
tlie child had wonderfully picked up since the operation of 40 Mg Of Levitra Too Much De-
cember 12, 1885. It had nursed well, slept well, and greatly
increased in size, being now a rather healthy looking child for
its age — two months.
January lOtJi. — Very little faecal matter had escaped since
yesterday. Two directors were introduced and a small quan-
tity came away. By separating the directors the opening was
As operative interference seemed to irritate the child, noth-
ing further was done until on January 17th. During this time
the abdomen had increased in 40 Mg Of Levitra Too Much size enormously, vomiting had
occurred after nearly every nursing (simply of the contents of
the stomach), and the napkins were only slightly stained. On
this date (January 17th, or sixty-four days after birth), under
chloroform, a dressing forceps was introduced and expanded.
The forceps was withdrawn and the dilator for the female
urethra introduced by Dr. Robert T. Wilson, of this city, was
passed with some little difficulty. The blades were separated
as far as possible (about half an inch), and gas and fseeal matter
escaped. The nozzle of a syringe was introduced, and the in-
jection of warm water brought away a quantity of feeces.
ISth. — Thecliild has had ten copious evacuations. The belly
is flat, lie has nursed well, has not vomited since the operation
of yesterday, and has slept quietly.
February 1st. — Since the last note the stools have been ir-
regular ; sometimes copious, at 40 Mg Of Levitra Too Much other times very small and few
in the twenty-four hours. On this date the unclosed opening was
again dilated under chloroform, so as to admit the little finger,
but very little faecal matter escaped. In the next twenty-four
hours the child had six good-sized evacuations, and did not
vomit at all (vomitinff of small quantities of milk, for a week
before February 1st, had been constant).
16th. — Since the last note the stools have 40 Mg Of Levitra Too Much been irregular —
sometimes five in the twenty-four hours, at other times none.
For the last forty-eight hours no stool has passed, and vomiting
has returned. The vomited matter is said by the parents to be
offensive, but colorless. Again the parts were dilated, under
chloroform, and a half-inch-diameter drainage-tube was intro-
duced well into the rectum. The tube was secured in position
by means of adhesive plaster, and the bowel washed out with
warm water. This brought away a large quantity of fsecal
matter and 40 Mg Of Levitra Too Much gas. Two hours afterward the tube was displaced
and not inserted again. The bowels continued to act well
through the artificial anus.
March 3d. — During the preceding two days only one stool
has occurred, and with great straining. The parts were again