Intestinal obstruction : its varieties with their pathology, diagnosis, and treatment / by Frederick Treves.

  • Treves, Frederick, 1853-1923.
Date:
1899
Catalogue details

Licence: Public Domain Mark

Credit: Intestinal obstruction : its varieties with their pathology, diagnosis, and treatment / by Frederick Treves. Source: Wellcome Collection.

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    gut acutely upon itself, just as a thin tube of indiarubber may be kinked. In the third form a certain part of the intestine is invagin- ated into the part immediately continuous with it. It is true that in this variety changes rapidly occur in the wall of the invaginated portion of the bowel, and that these changes play a very important part in the production of obstructive symp- toms. Such changes are, however, secondary and, in a limited sense, accidental. In the fourth variety the lumen of the bowel is simply blocked, the obstructing agent having no structural con- nection with the intestinal wall. The fifth variety of intestinal obstruction—that known as stenosis—calls for more detailed consideration. In this mechanical form the lumen of the bowel is narrowed, but such narrowing may be due to two perfectly distinct causes. In the first of these two kinds the stenosis is due to changes in the bowel wall itself In that wall there is a growth or a cicatrix whereby the lumen is narrowed and obstruction symptoms are produced. This sub-variety is illustrated by the many forms of stricture which may be due to a malignant growth of the gut on the one hand or to the contracting cicatrix of a non- malignant ulcer of the bowel on the other. In the second of the two forms of stenosis the lumen of the bowel is narrowed by changes which are outside and beyond the actual intestinal wall. This kind is illustrated by cases in which the bowel is compressed by a tumour—such as a cancerous uterus^out- side the canal or by contracting peritoneal adhesions, or by a diffuse growth which has arisen beyond the bowel but has grown around it and compressed it. As a further amplification of the table above given, a classification may be based upon the degree of the obstruc- tion, for it is evident that cases of intestinal blocking may be divided into those in which the lumen of the tube is completely occluded and those in which the closure is in- complete, and the passage is only imperfectly obstructed. Such a classification arranges itself as follows:— 1. Occlusion. Closure of lumeu of gut complete. Passage of contents impossible. Illustrated by (1) strangulation and (2) torsion. 2. Obstruction. Closure of lumen of gut incomplete. Passage of contents difficult. Illustrated by (3) invagination, (4) obtura- tion, and (5) stenosis. It is unnecessary to state that considerable differences both as regards symptoms and prognosis, exist between the