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Category: Digestive Organs
Causes. This may be caused by strangulation,
telescope (intussusception) of the bowels, twists and knots, strictures
and tumors, abnormal contents.
1. Strangulation is the most frequent cause; this is caused by adhesions
and bands from former peritonitis, or following operations. The
strangulation may be recent and due to adhesion of the bowels to the
abdominal cut or wound, or a coil of the bowel may be caught between the
pedicle of a tumor and the wall of the pelvis. These cases are rather
common after some operations.
2. Intussusception. This means that one portion of the bowel slips into
an adjacent portion. These two portions make a cylindrical lump varying in
length from one-half inch to a foot or more. Irregular worm-like motion of
the bowel is a cause of intussusception.
3. Twists and knots. Most frequent between thirty and forty. (There is an
unusually long mesentery.)
4. Strictures and tumors. These are not very important causes.
5. Abnormal contents. Fruit stones, coins, pins, needles, false teeth,
round worms rolled in a mass. Coins rarely cause inconvenience.
Symptoms of Acute Obstruction. Constipation, pain in the bowels, and
vomiting are the three most important symptoms. Pain sets in early, and
may come on abruptly when walking or more commonly when working. It is at
first colicky, but soon becomes continuous and very intense, vomiting soon
follows and is constant and very distressing. First the stomach contents
are vomited, and the greenish bile-stained material, and soon the material
vomited is a brownish-black liquid, with a bowel odor. This peculiar
vomiting is a very characteristic symptom. Constipation may be absolute,
without the discharge of either feces or gas. Very often the contents of
the bowel below the obstruction are discharged. The abdomen is usually
distended and when the large bowel is involved this is extreme. If it is
high up in the small intestine, it may be very slight. At first, the
abdomen is not tender, but later it becomes very sensitive and tender. The
face is pale and anxious and finally collapse symptoms intervene. The eyes
are sunken, the features look pinched and a cold, clammy sweat covers the
skin. The pulse becomes rapid and weak. There may be no fever, and it may
go below normal. The tongue is dry, parched, and the thirst is incessant.
Recovery. The case terminates as a rule in death in three to six days,
if aid is not given.
Treatment. Purgatives should not be given. For the pain, hypodermics of
morphine are needed. Wash out the stomach for distressing vomiting. This
can be done three to four times a day. Thorough washing out of the large
bowel with injections should be practised, the warm water being allowed to
flow in from a fountain syringe and the amount carefully estimated.
Hutchinson recommends that the patient be placed under an anesthetic, the
abdomen kneaded, and a copious enema given with the hips placed high or
patient in inverted position. Then the patient should be thoroughly
shaken, first with the abdomen held downward and subsequently in the
inverted position. If this and similar measures do not succeed by the
third day surgical measures must be resorted to.
For bloating, turpentine cloths should be used, and other hot, moist
Diet. Should be very light, if any, for a day or so.
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