President's Address: The Clinical Aspect of Congenital Mesenteric Malformation in Children.
(1) Congenital malformations of the mesentery are a definite morbid entity of a chronic type which may be recognized, before operation, by careful clinical investigation. (2) The symptom-complexes to which they give rise cannot be explained by reference to any of the well-known abdominal surgical diseases; still less by any purely functional disability which may be included under the term "indigestion." (3) The most important physical sign is the "emptiness" of the right iliac fossa, associated sometimes with an asymmetrical enlargement of the abdomen on the left side. These signs follow of necessity, inasmuch as the whole segment of the embryonic mid-gut is involved in a failure of rotation and fixation after reduction from the umbilical sac. (4) Radiological investigation should prove to be more helpful in confirming the clinical diagnosis when the special method of examination already described is used as a routine. (5) Operative treatment may cure the patient; alternatively it may reveal a pathological condition for which a rational course of treatment may be drawn up subsequently, when the precise details of the malformation have been discovered.