Intestinal Obstruction.


Definition.—A partial or complete occlusion of the intestinal canal, due to compression of the bowel, invagination, twisting, adhesions, or foreign bodies.

Etiology and Pathology.—It may arise from various causes, among which may be enumerated: "1. Bands of adhesion, the result of inflammatory action; 2. From a congenital intestinal pouch becoming adherent; 3. From the appendix ceci assuming a fixed and adherent position; 4. From the twisting of the intestine upon its own axis, upon the mesentery, or upon other coils of intestine; 5. From tumors developed in the mesentery, leading to constriction; 6. From intussusception; 7. From cancerous disease of the intestine; 8. From contraction of cicatrices, as after dysentery or fever; 9. From enteritis or peritonitis; 10. From impaction of feces, or of foreign bodies, as gall-stones, etc.; 11. Obscure forms of hernia, as into the obturator foramen, etc.; 12. Prolapsus-ani and inflamed hemorrhoids; 13. Abdominal or pelvic tumors." (Habershon.)

Some of these cases are readily determined, and may be excluded from the subject, as enteritis, peritonitis, prolapsus-ani, inflamed hemorrhoids, and abdominal or pelvic tumors. Again, it has been contended by some authors that all the symptoms found in these cases may be produced by .a spasmodic state of the intestine, no strangulation or cause of obstruction being detected after death.

Symptoms.—"In the early stage of the affection, the patient is obstinately constipated, and complains of an uneasy sensation at the part where the obstruction exists, being sometimes able to place the hand directly on the part. In a longer or shorter time he complains of a twisting or violent pain about the umbilicus, without tenderness on pressure; in fact, frequently relieved by it. Nausea comes on, with frequent retchings, vomiting of the contents of the stomach, then of bile, and finally of feculent matter.

"The abdomen becomes very much distended by gas, is tense and tender, the countenance shrunken and anxious, the extremities cold, with frequently cold, clammy perspiration, hiccough, and gradual failure of vital power.

"The disease pursues a variable course. Sometimes the suffering is extreme at the commencement, and all the worst symptoms above named appear in twenty-four or forty-eight hours; in others, the disease will not terminate fatally under six or seven days; and in some cases the large intestine being the seat of the obstruction, it may last for three or four weeks."

Diagnosis.—"Much difficulty is experienced in detecting the character of these cases, as the symptoms at first are none of them distinctive. If of sudden occurrence, as when the patient feels a sudden, severe, colicky pain when straining at stool, becoming more and more severe, and attended with tenesmus and constant desire to go to stool, but unable to pass anything from the bowels, we have a tolerably plain case.

"In other cases we are led to believe that there is intestinal obstruction by the continuance of the constipation, sufficient means having been used for its removal; by the fixed location of the severe pain, and the constant nausea and marked prostration. At a later stage, the continuance of all the above symptoms, and the appearance of stercoraceous vomiting, are positive evidence.

"If the patient has had peritonitis, we have reasonable ground to conclude that it results from adhesions. Tumors are likely to have given rise to previous uneasiness, and to be so developed as to be diagnosed on examination. Cancer will have been of long duration, and given rise to disturbance of the bowels, and the ileus of slow formation. Impaction of feces may sometimes be determined by the hard, irregular tumor that presents, and its sudden appearance; obscure hernia by its location and the circumscribed character of the pain."

Prognosis.—"The prognosis in these affections is unfavorable, though many recover. If there is continued increase in the severity of the symptoms, the nausea and vomiting being intense and persistent, and especially of stercoraceous material, with great prostration and anxiety, the prospect is very poor. If, however, the bowels are moved, the pain being mitigated, the patient will recover. In some cases of intussusception, when the symptoms are very severe, the patient still retains his strength, the nausea abates somewhat, and after two, three, or four weeks of suffering, a portion of the intussuscepted bowel is discharged, and the patient recovers. So many of these have occurred, that we would not despair, even after having employed all the means recommended without success, for nature will sometimes step in, and thus save the life of the person."

Treatment.—"In almost all cases purgatives will have been thoroughly tried before we are called, so that we will not have to regret the giving them as one of our errors; still, cases will undoubtedly occur in which symptoms will be so obscure that we will administer them ourselves, to the great detriment of the patient. In all cases, the administration of opium and an infusion of dioscorea, in sufficient quantity to relieve the pain, will be all the internal medicine usually of use. The nausea must be quieted as much as possible, by the use of the means heretofore named: an infusion of compound powder of rhubarb, peach bark, subnitrate of bismuth, ice, morphia, etc., and the employment of counter-irritation to the epigastrium. The association of chloroform, sulphuric ether, or tincture of gelsemium will be advantageous in some cases, the two first especially in cases of tympanitis.

"To relieve the obstruction, large quantities of fluid—thin gruel is as good as anything—should be thrown up the bowel with a pump syringe. As much as from half to one gallon may be thus used, completely distending the large intestine. This may be repeated several times per day; or, what is deemed even better than this, the introduction of air by means of an air-pump, until the large intestine is distended to its full extent. Change of position is sometimes advantageous, at others hurtful, and the same may be said of the sudden application of cold water. Great relief may sometimes be given by the use of the hot sitz-bath, and occasionally by the use of hot fomentations to the abdomen.

"The question of surgical interference in bad cases becomes one of anxious consideration, as in some cases the obstruction is of such character as that it might thus be relieved with the greatest facility. Mr. Hilton has resorted to this mode of relief with success, but others have signally failed. When it can be determined that the obstruction is of the large intestine, the operation for artificial anus offers the best chance for success. If the means first named do not prove successful, we endeavor to prolong the patient's life, hoping that nature will step in and remove the obstruction. We thus use stimulants in small quantities, and nutritious enemata, and such means as will relieve the sufferings of the patient as much as possible." (Scudder's "Practice.")

The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.