Ileal stasis / by Lewis Gregory Cole, M.D. New York.

  • Lewis Gregory Cole
Date:
[1914?]
Catalogue details

Licence: In copyright

Credit: Ileal stasis / by Lewis Gregory Cole, M.D. New York. Source: Wellcome Collection.

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    9 w THE CANADIAN MEDICAL grams are used by the surgeon to demonstrate a preconceived diagnosis and to force the patient to submit to surgical procedure. Jordan told me that at first he seldom found roentgenologic evi¬ dence of kinks in the various portions of the small intestine, but that Mr. Lane told him they were there, and that he must find some way to demonstrate them roentgenographically. This he proceeded to do, and very graphically described among other pnenomena the writhing duodenum, due to obstruction at the duodeno-jejunal junction. Now this condition does exist, and I have demonstrated it roentgenocinematographically, but it is not found with anything like the frequency that some observers would lead us to believe. A writhing duodenum may be obtained in any case, as Holzknecht has shown, simply by exerting presure on the duodeno-jejunal junction and pressing it against the spinal column. Great care must therefore be observed to differentiate between real and artificial obstruction at this point. There are likewise cases supposed to be suffering from kinks of the terminal ileum and ileal stasis, which show no roentgenologic evidence of delayed evacuation at this point. The roentgenologic diagnosis in such cases is based on mobility under deep palpation of certain localized areas of the terminal ileum during fluoroscopic examina¬ tion. Personally, I believe that this is insufficient evidence upon which to base a diagnosis of ileal stasis requiring surgical relief. In other instances the diagnosis of intestinal stasis has been based on the length of time during which bismuth was observed in the terminal portion of the ileum after its ingestion. For this consideration the fundamental question is,—what is the normal time for the bismuth to remain in the terminal ileum? Jordan, in his recent tour of this country, illustrated cases of “ ileal stasis requiring surgical procedure ” by demonstrating slides showing retention in the terminal ileum six, six and one-half, and seven hours after the ingestion of bismuth. When I put the question to Sir Arbuthnot Lane, he stated that he “felt uneasy about ileal stasis after the seventh hour following the ingestion of bismuth.” Ac¬ cording to Lane, therefore, seven hours is the limit of time during which chyme may normally be found in the ileum after the inges¬ tion of bismuth-impregnated food. I habitually make roentgeno¬ grams of the entire gastro-intestinal tract during the seventh hour after ingestion and in more than 98 per cent, of all the cases ex¬ amined bismuth has been found in the ileum at that time. In fully one half the cases there is a trace of chyme in the stomach, cap or duodenum during the seventh hour. In other cases, par¬ ticularly if the stomach is of the cow-horn type, complete gastric
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