The practice of surgery / by James Gregory Mumford ... with 682 illustrations.

  • James Gregory Mumford
Date:
1910
Catalogue details

Licence: Public Domain Mark

Credit: The practice of surgery / by James Gregory Mumford ... with 682 illustrations. 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.

    54/1044 (page 50)
    From such observations tlu^ reader will see that a shai'p distinction must be made between obstruction associated with strangulation and obstruction not so associated. Obstruction from strangulation is immediately grave. There is no anastomosis between the terminal mesenteric vessels supplying the intestine, so that occlusion of any of the mesenteric arteries results promptly in necrosis of the corresponding gut. Therefore, when pronounced s}niptoms are present, associated with obstruction, we fear strangulation, ^^'hen the s}-niptoms are of a milder grade, we may conclude an obstruction without sti'angulation, and take our measures accortlingly. Diagnosis of Acute Intestinal Obstruction.—A suggestion of the general condition of acute obstruction has already been given in the discussion of symptoms. One sees at a glance, from the Hippocratic face, the expression of distress, the shortened respiration, the dorsal decubitus, the flexed thighs, the tender, distended abdomen, the story of constipation, pain, and vomiting, and the rapid, compressible pulse, that a serious intra-abdominal disease, is present. Sometimes pal- pation will reveal the seat of mischief; often the distention masks the lesion. The ]30ssible absence of tympany, combined with the other signs, may suggest an obstruction high in the small intestine. In this case the vomiting is not stercoraceous. Obstructions lower down, especially in the colon, give opportunity for more and more pronounced distention. Examination of the rectum may disclose the cause of the obstruction, or injection of the colon with air or water may demon- strate the seat of trouble. The adult colon, normally, should contain 6 quarts of fluid; if one can introduce less than 4 quarts, there is prob- ably obstruction of the large intestine. The age of the patient may have an important bearing on the diagnosis. The history of hernia, or the discovery of a hernia present, will settle the diagnosis. The fact of internal concealed hernia cannot definitely be ascertained. Obstruction in a young child, especially if there be a recent history of colicky pains and bloody, mucous stools, with the occa- sional presence of a rounded or sausage-shaped tumor, suggests intus-. susception. The history of a previous abdominal section may indicate strangulation by a band, by adhesions, or the possible presence of a lost sponge or instrument. The onset of sudden pain, with collapse, tumor, and bloody stools, may indicate volvulus. An obstruction due to Meckel's cHverticulum is almost impossible of diagnosis, so closely are its symptoms simulated by an acute appendicitis. Gall-stones may obstruct. In such a case one expects to find a histor}^ of disease of the bile-passages, and probably of a previous passage of gall-stones. Th^ presence of other foreign bodies frequently may be assumed from the history. In spite of these apparently definite suggestions, it is not by any means possible to make a positive diagnosis in all cases of acute intes- tinal obstruction. In a large hospital experience, embracing dozens of these cases annually, given the above symptoms, one sees made commonly the diagnosis of appendicitis, intussusception, peritonitis