Intestinal obstruction due to gall-stones : report of three cases, with summary of five more cases from the records of the London Hospital, 1893-1901 / by H.L. Barnard.

  • Barnard, Harold Leslie, 1868-1908.
Date:
[1902]
Catalogue details

Licence: In copyright

Credit: Intestinal obstruction due to gall-stones : report of three cases, with summary of five more cases from the records of the London Hospital, 1893-1901 / by H.L. Barnard. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    jection in the gut, and could by no reasonable pressure be passed on along the gut. This spasm of the intestine would also account for the success which in former days attended the exhibition of morphia and belladonna in some cases, since these are drugs capable of relaxing this spasm. Another point of interest about these cases is that there is no true strangulation of intestine. They are pure cases of obstruction to the contents of the small intestine without inter- ference with its blood supply. It follows from these considera- tions that the gut is not paralyzed throughout, as it is in most other cases of acute intestinal obstruction, and a recognition of this fact will make the anomalous symptoms of gall-stone obstruction easy to understand. These symptoms may be summarized thus: The onset is sudden. The pain and collapse are seldom severe until late in the attack. The constipation is illy marked, and in many cases the patients have passed flatus and even small motions after the onset of the acute symptoms. In Cases I, II, and IV purgatives and enemas produced a motion even when the calculus was in the intestine. The abdomen is neither tender nor markedly distended as a rule. The prominent symptom is vomiting, which is severe, continu- ous, profuse, and early deeply stained with bile, so as to closely simulate faecal vomiting. In a case of Dr. Pye Smith’s quoted by Treves,10 where the stone was impacted in the upper jejunum, the patient vom- ited one and one-fourth gallons of bilious fluid in forty-eight hours, and died on the sixth day. The vomiting, moreover, in Cases I and II could be divided into three stages. In the first it was sudden in onset and severe and profuse in character. In the second stage, when the stone had moved from a close proximity to the stomach, it remitted. In the last stage, when the stone became impacted lower down, it returned, and was like the faecal stage of ordi- nary acute intestinal obstruction. The calculus was probably felt in Douglas’s pouch in Case I, and was certainly felt in the region of the ileocaecal