"Case of strangulation of the ileum in an aperture in the mesentery"

(23 June 1846)Presentation before the Royal Medical and Chirurgical Society on 23 June 1846.

Six case presentations occurred on this Tuesday evening, the last meeting of the Society in the current session. Minutes were taken by the Society and distributed to the medical journals. Snow's presentation was recorded as follows:

"The subject of this case was a lady, aged twenty-four. When in the eighth month of pregnancy, she was seized with severe pain in the belly, of an intermitting character, with sickness and vomiting. She thought labour was coming on; but there was no dilation of the os uteri. The symptoms throughout her illness were those usually arising from some mechanical obstruction in the bowels, and in spite of all the remedies employed, they continued, with more or less severity, until her death, which took place on the fourth day.

An examination of the body was made twenty-four hours after death, and the morbid appearances are fully detailed. On examining the preparation which was on the table, the vermiform appendix is found enclosed within a double layer of peritonaeum, which forms a kind of broad ligament, which is attached above to the caecum and ileum, and externally and inferiorly to the iliac fossa and brim of the pelvis. On the outer side of the vermiform appendix there is an aperture in this membrane with defined edges, through which the thumb can be passed; and behind the portion of it, which extends with a curve from the appendix to the ileum, there is a pouch, into which a finger can be passed for about two inches. The thin membrane passing across from the vermiform appendix to the ileum, and leaving the aperture through which the aperture took place, forms an extension of the above-named curve.

The author remarks that there are many cases on record of strangulation of the bowels from adhesion of the vermiform appendix with neighbouring parts; but the appearance of the membrane in this case, with the absence of the evidence of old inflammation, and the circumstance that the membranous band appears to be a natural continuation of a larger fold, leads him to consider it as a congenital production of the peritonaeum, leaving an aperture on the inner side of the appendix vermiformis similar to the one seen on its outer side."

[Appeared as "Case of Strangulation of the Ileum in an Aperture of the Mesentery," LMG 38 (1846): 125; MT 14 (1846): 299-300; Lancet 2 (1846): 45.

This presentation, in all likelihood revised, was published, with an illustration; see "Case of strangulation of the ileum in an aperture of the mesentery," LMG (18 December 1846): 1049-52.]