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Categories: 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
etween 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.