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Full text of "Medical Jurisprudence And Toxicology"

272                                              MEDICAL JURISPRUDENCE

When caused by injury rupture may take place at the point of impact,
or in some cases at a distance from it. In the former case the margins of
the rupture are clean cut, and in the latter they are usually ragged and
irregular. Rupture usually occurs at the commencement of the jejunum,
and in the lower three feet of the ilieum, but very rarely in the large
intestine. However, it must be remembered that rupture of the large
intestine at the junction of the sigmoid with the rectum may occur from
straining at stool without the presence of chronic ulceration or any other
disease.

Death occurs immediately from shock or subsequently from peritonitis
owing to the expulsion of the contents into the peritoneal cavity. In three
out of ten cases of mechanical violence to the small intestine that came under
my observation death occurred from peritonitis on the third, fourth and
sixth day respectively after the rupture. In one case the intestine was
diseased and it was the chronic ulcer that had given way.

If a rupture is very small the mucous membrane becomes everted and
closes the little opening and thus prevents the escape of the intestinal
contents. The power of locomotion or other muscular exertion may be
preserved after these injuries.

Rectum.—Owing to its anatomical situation in the hollow of the
sacrum the rectum is rarely injured except from wounds through the
perinaeum and ischiorectal fossa, but it may rupture spontaneously. Allen37
reports a case in which a male, aged 54 years, felt a sudden moderately
severe pain in the lower part of the abdomen, while walking to his work
after his midday meal. On examination a transverse tear, 14 inches long,
was observed in the anterior wall of the first part of the rectum. The
rectum and splenic colon were normal.

Fatal injuries of the rectum are sometimes produced by the forcible
thrusting of a blunt weapon through the anus, a method of torture, which
is occasionally resorted to in India for adultery and theft.

Roy Chowdhury reported to me a case, in which he examined the body of one
Bhogla, aged 11 years, and he found that a bamboo, 12 inches long, had been thrust
through the anus into the abdominal cavity, where it produced a tear of the transverse
colon and then entered the pleural cavity tearing through the diaphragm. A case38
is reported, where the husband of a woman inserted a chopstick into the rectum of a
man, 30 years old, who was found in bed with his wife. The chopstick remained in the
lower bowel for fifty days, and then penetrated the ascending colon making two per-
forations and causing peritonitis. The chopstick was removed by an operation and the
two perforations were repaired. The patient recovered.

Severe injuries of the rectum may also occur from the self-insertion
through the anus of a foreign body, such as a bamboo piece, a bottle, etc.,
owing to perverted sexual practice, from falling accidentally on an iron
railing or any projecting point or from sitting forcibly upon a piece of a
broken bottle or broken china.

Pillai39 describes the case of a Burman male who sustained a penetrating wound
of the anus by falling down a paddy heap, 14 feet high, on to a forked stick used for
supporting a country cart. The wound involved the anus and surrounding skin. Two
loops of the small intestine, each about 1J feet long, with a piece of omentum, about
If feet long, were protruding through the wound and lying loose over the peri-
nseum. The gut was lacerated, gangrenous and offensive. On examination by the fingers
a gaping wound was felt on the right side of the rectum, extending into the abdominal
cavity. The abdomen was tympanic and tender. Recovery took place after an operation.
James40 also describes a case in which a farmer, 18 years old, while working in the
hay fields jumped backward from a waggon and impaled himself upon the upright handle

37.    Lancet, Sep. 4,1948, p. 378; vide also Arnold S. Aldis, Lancet, Sep. 25, 1948, p. 511.

38.   Paul Teng, Western Jour. Surgery, Obstetrics and Gynaecology Oct. 1947 : Medical
Press, Dec. 17, 19*7, ^ $45,                      - --

39.   Ind. Med. Gaz.> Sej^ 1933, j>. 519.

40.   Lancet, Feb. 11, 18$9, p. 326.