Licence: In copyright
Credit: Aids to surgery / by Joseph Cunning. Source: Wellcome Collection.
Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.
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![patient. If the condition is allowed to go on, the patient dies of peritonitis from perforation above the stricture, or migration of the Bacillus coli through the paralyzed wall, or from poisoning by absorption of the intestinal contents. Treatment.—Unless the case has become one of acute obstruction, it should be treated temporarily by fluid diet, copious enemata, and small doses of calomel combined with belladonna. An early operation should, however, be advised in all cases but those of fsecal impaction. It the obsiruciion has become com]3letc, the abdomen must be opened. If the small intestine is obstructed, a coil above must be draine 1 with a Paul's tube, leaving the cause to be dealt with later. If the obstruction is in the large intestine, the colon must be opened and drained with a Paul's tube, either in the usual situation for colotomy, or, if the stricture is above the sigmoid, a piece of the ileum a foot away from the caecum is opened and stitched to a median wound. In chronic peritonitis diet, enemata, and abdominal massage, must be trusted to unless the obstruction is acute. Intussusception. A portion of the bowel becomes invaginated into the part below. The invaginated portion is called the intus- SUSceptum ; the portion into which it is protruded, the intussuscipiens. There are, therefore, three layers—the outer or ensheathing layer, the inner or entering layer, and the middle or returning layer. Not only does the intestine enter, but also the mesentery ; so that, in addi- tion to the obstruction due to traction, strangulation from pressure on the bloodvessels is added. Peritonitis usually follows from migration of the Badlhis coli. This maybe limited, and merely cause adhesions between the entering and returning layers, or may be diffuse and fatal from perforation or gangrene. Causes. — It is due to irregular peristalsis, a contracted portion of the intestine being forced into the lumen of the bowel immediately below. Irritating ingesta, polypoid tumours, and malignant growths, may be the cause of the irregular peristalsis.](https://iiif.wellcomecollection.org/image/b21510891_0352.jp2/full/800%2C/0/default.jpg)
