Acute peritoneal infection and its relation to intestinal obstruction / by James P. Warbasse.
- James Peter Warbasse
- Date:
- 1905
Licence: In copyright
Credit: Acute peritoneal infection and its relation to intestinal obstruction / by James P. Warbasse. 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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![the peritoneum is intensely inflamed, a paralysis of much of the intestine rapidly develops, and the patient dies with all the symp- toms of intestinal obstruction and with scarcely any fluid in the peritoneal sac. Here the disease is distinctly a disease of the bowel. In thrombosis and embolism of the mesenteric vessels a complete paralysis of the bowel results from the discontinuance of the blood circulation. Here is a condition which comes under the heading neither of peritonitis nor intestinal obstruction, yet it so closely resembles these that it is commonly mistaken for one or the other. So striking is the similarity to intestinal obstruction that Deckart' in his work on thrombosis and embolism of the mesentric vessels gives it the sub-title of “A Contribution to the Study of Ileus.” A perforation of the stomach posteriorly, causing a circum- scribed peritonitis, gives an entirely dift’erent picture from that of a perforation of the small intestine with the same area of peritonitis. The mere matter of septic absorption from the peritoneum is here shown to be of little importance, notwithstanding the much talked of absorbent power of the diaphragmatic peritoneum. The case with the perforation of the intestine dies with the symptoms of intestinal obstruction. The stomach case, if the bowel is not par- alyzed, presents no more S}Tnptoms of sepsis than it would if the same pus were confined in an abscess of the lumbar muscles. Puerperal peritonitis is a particularly fatal disease, and it is often cited as an example of the serious character of peritonitis. The patient often dies before a paralysis of the bowel has had time to develop. The symptoms are those of profound septic intoxication. Here the peritonitis is not the chief thing, as is generally taught. The infection is due to a streptococcus of great virulence, and while the peritoneum is involved, there is also an involvement of the uterus and the rich lymphatic structures of the broad ligament and the pelvic spaces, and in many cases the patient dies before peri- tonitis has begun. There are other cases without symptoms of intes- tinal obstruction or meteorism. These are often cases with empty intestines, or cases in which the gas-producing oi*ganisms in the intestines are few, or cases in which the infecting organism was not capable of penetiating the intestinal wall. Such cases are very rare. ^^ hen we come to consider the morbid phenomena of acute intestinal obstruction, we discover that the .symptoms of this con- dition are not alone due to the simple interruption of the fecal current. This alone does not su])ply a satisfactory explanation. The.se symptoms are complex, and depend upon the absorption of stercoral ])roducts, upon circulatory disturbances in the intestinal wall and me.sentery, and upon disturbances of the nerve functions in the.se parts. Aside from the j)athological changes which show > Grenzgeb. d, Med. u. Chir., 1900, vol. v.](https://iiif.wellcomecollection.org/image/b22419834_0009.jp2/full/800%2C/0/default.jpg)
