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.

    32/596 (page 16)
    ii; volvulus. No distension of the intestine can equal that ex- hibited by a volvulus of a sigmoid flexure of exceptional length ni which the mesocolon has been so twisted as to cut off the blood supply from the whole coil. Thrombosis of the mesenteric vessels tends to favour intense meteorisra. In- deed, one of the most extreme examples of flatulent distension of the abdomen which I have seen occurred in a patient who had no intestinal obstruction, but who exhibited jjost mortem extensive thrombosis of the mesenteric veins. In the cases of intestinal obstruction the mcteorism is obviously favoured by the loss of contractility in the bowel, and this condition is very marked when the circulation in the loop has been arrested. (Compare Groups II. and III.) The advent of peritonitis increases the degree of paresis, and is followed by an augmentation of the mcteorism. Mere abrupt occlusion of the gut without disturbance of its circulation leads to an accumulation of the bowel contents above the strictured part. Gas collects at this point, and is unable to escape downwards, but the actual distension of the bowel produced is, in these acute cases, compara- tively slight, and can hardly be said to reach the degree of mcteorism. The General Pathology of Obstruction of the Bowel.—The condition to be considered under this heading is illustrated by stricture of the bowel or any stenosis of gradual formation. The bowel is narroAved, but not oc- cluded. The intestinal contents can pass, iDut pass with difficulty. There is obstruction, but not occlusion. It is to be assumed that the narrowing has formed slowly and gradually, and therefore that the case is chronic. The best example of this condition is afforded by a malignant stricture of the colon. The bowel below the obstruction is empty and con- tracted. It contrasts in a very marked manner with the intestine above the seat of stenosis. It is in a state of feeble tonic contraction, the so-called inanition contraction, its colour is pale, and its walls are unchanged. It is in the con- dition, in fact, of the starvation intestine. Now and then it may show some distension due to gas produced by the decomposition of such uiatters as have passed through the strictures. These matters in neglected cases may form sub- stantial accumulations in the bowel, and may even be retained long enough to induce catarrh. The rectum below an obstructed colon may be found to be dilated, and in the condition known as the ballooned rectum. This curious state is apparently the result of some nerve disturbance,