Acute Enteric Intussusception with Apparent Reduction by Irrigation.

William Templeton, in The British Medical Journal, reports this interesting case. A boy three years old had an Acute enteric intussusception. There was a slight general swelling of the abdomen and tympanites, with a quite definite elongated swelling, not at all sausage-shaped, about two inches long and one inch broad, lying obliquely downward and inward in the left iliac region, dull on percussion. Rectal examination showed nothing abnormal. A pint of warm water was gradually injected into the bowel, which was followed by a disappearance of the tumor.

On the day following, the abdomen was found to be again distended and tympanitic; and the tumor was again present as before; it was hard and dull on percussion, but not tender. A large enema of warm water was injected, and the tumor again disappeared completely. Three hours later it reappeared.

While the child was being prepared for abdominal section and while he was under chloroform, and enema was again injected, with a complete disappearance of the tumor.

In a few moments it reappeared. At the operation an invagination of the bowel was found, about two inches or so in length. This was easily reduced. The child recovered well from the operation and passed a large distinctly fecal motion; but 36 hours after the operation he became collapsed and died.

This case is interesting in relation to the question whether cases of acute intussusception should be operated upon as soon as definite diagnosis is established, or whether irrigation or inflation of the bowel should first be tried. In the enteric variety, which forms about thirty per cent of all cases, irrigation cannot possibly be of any use, and may, as in this case, cause delay in resorting to abdominal section.

Charlotte Med. Jour.

Ellingwood's Therapeutist, Vol. 2, 1908, was edited by Finley Ellingwood M.D.