The surgical treatment of wounds and obstruction of the intestines / by Edward Martin and H.A. Hare.

  • Edward Martin
Date:
1891
Catalogue details

Licence: Public Domain Mark

Credit: The surgical treatment of wounds and obstruction of the intestines / by Edward Martin and H.A. Hare. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    or even years, but in the acut(! forms tlic ])rog;nosis must be, for cases not treated surin;;i('ally, abiiost absolutely bad. Haven states that the average expectation of bfe is about five days. Symptoms.—Absolute constipation, vomiting, which gradually becomes feculent, and abdominal distention are present in volvulus as in other forms of intestinal obstruction. According to the seat and nature of the twist symptoms will vary somewhat, being characterized by violence of onset and rapidity of course in pro- portion to the tightness of the twist. The sigmoid flexure being the commonest seat of trouble, the symptoms of its involvement are usually taken as a type of this displacement in general. A history of constIpatioii.-^As the pathological condition neces- sary for the formation of the twist requires a long period for its development, there is commonly a history of previous constipation. This was observed in 70 per cent, of Treves's cases. Pain.—The acute onset may be determined by a long-continued constipation. The attack is usually inaugurated by sudden, severe, but not absolutely agonizing pain, felt about the umbilicus, or ex- ceptionally at the seat of trouble. This is constant with exacerba- tions, but gradually diminishes. It is accompanied by a moderate degree of shock or nervous prostration. Shortly following the pain, tenderness is manifest, as a result of the early lighting up of local peritonitis. Treves states that peritonitis is nearly always quickly developed, in connection with volvulus. Haven's tables, however, show that this complication is not more common than in internal strangulation. Constipation.—This is one of the most constant symptoms, and in all of Plaven's cases it Mas present. It is usually absolute. In a small percentage of cases it has been preceded by diarrhoea. Very frequently tenesmus is a prominent feature. Vomiting.—This is much less constant than in internal strangu- lation and is usually not fecal. It is frequently slight and rarely repeated, and in some cases is altogether absent. Meteorism.—This symptom is usually very well marked. In- deed, it is in this form of intestinal obstruction that the abdominal distention reaches its extreme limit. At first the swelling is con- fined to the region of the colon, if the twist is in its usual position. Later the small intestine is involved, as peritonitis destroys its 4 ' .