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I . Congenital dislocation of the shoulder is a well-documented condition, and twenty examples are to be found in the literature since 1839. Of these seven were bilateral. 2.A new bilateral instance is described, and the treatment reviewed.I am grateful to Mr. R. Watson-Jones for his advice in connexion with this patient.
I . Congenital dislocation of the shoulder is a well-documented condition, and twenty examples are to be found in the literature since 1839. Of these seven were bilateral. 2.A new bilateral instance is described, and the treatment reviewed.I am grateful to Mr. R. Watson-Jones for his advice in connexion with this patient.
THE following case of imprisonment of the small intestine, owing to a congenital defect in the mesocolon, is reported because of the rarity of the condition.Case Report F. R., an 8-year-old schoolboy, entered the Peterboro, New Hampshire, Hospital on August 1, 1939, complaining of severe abdominal pain. The family and past histories were noncontributory except for an indefinite history, extending back for more than a year, of poorly localized attacks of abdominal pain lasting from 1 to 3 hours and unaccompanied by vomiting, fever or evidence of infection.During the morning of the day before admission, the patient rode horseback and appeared to be well. He refused luncheon and later refused his supper, but made no complaint until the night preceding admission, during which his sleep was restless and he complained of abdominal pain. The boy stated that he had had a stool during the afternoon before admission, but this statement could not be corroborated. By morning he was complaining bitterly of abdominal pain, which he referred to the midabdomen and to the right side. He did not vomit or complain of nausea. On admission the mouth temperature was 98.6"F., the pulse rate 70, and the white-cell count 4000 with 53 per cent polymorphonuclears. The local physical examination was made with difficulty, but his physician, Dr. Donald Clark, found tenderness in the right lower quadrant without other positive physical findings in the abdomen. Rectal examination revealed a large amount of inspissated feces and tenderness more marked on the right side. Two enemas were administered and were returned with formed fecal masses. Pain appeared to be aggravated by the enemas, and the patient spent the morning in a kneechest position, which he assumed because of pain. One examination of the urine was negative. At noon the white-cell count had risen to 12,000, and the polymorphonuclears had increased to 90 per cent. There had been no vomiting and no apparent nausea.Shortly after 1 p.m., I examined the patient in company with Dr. Clark. The child was in bed in the knee-chest position, which could be altered only after great protest.He would consent to be on his left side with the lower extremities flexed on the abdomen, and with great difficulty he was persuaded momentarily to be recumbent with the legs extended. The mouth temperature was then 99°F., the pulse 64. The faciès were expressive of pain, the skin was cool and clammy, but he did not appear to be in deep shock. The general physical examination was not remarkable. The abdomen was not distended, and there was no intestinal patterning or visible peristalsis. There was no muscle spasm, but there was excruciating tenderness throughout the right side of the abdomen, with no recognized point of maximum tenderness. Palpation of the left side of the abdomen caused no pain. No masses were felt. Rectal examination was negative. During examination the child appeared nauseated but did not vomit.Laparotomy was performed at 2 p.m. without a preoperative diagnosis having been made.Under averti...
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