550 THE DIGESTIVE SYSTEM. 



WOUNDS-RUPTURES. 



Penetrating wounds of the intestine usually prove rapidly fatal, either 

 from shock or from peritonitis. Sometimes, however, the wound be- 

 comes closed by the formation of adhesions with the neighboring parts. 

 Sometimes the wound in the intestines becomes adherent at the position 

 of the wound in the abdominal wall, and an intestinal fistula is formed. 



Eupture of the small intestine is not infrequently produced by severe 

 blows on the anterior abdominal wall. It is noticeable that such blows 

 may not produce marks or ecchymoses of the skin. Such ruptures 

 usually prove fatal very soon, but sometimes the patient lives several 

 days and the edges of the rupture undergo inflammatory changes. 



Strictures of the intestine are sometimes followed by rupture of the 

 dilated intestine at some point above the stricture. ' 



DISTURBANCES OF THE CIRCULATION HAEMORRHAGE. 



Hypersemia of the intestine may be inflammatory in character or it 

 may be associated with disturbance of the portal circulation. Under 

 both of these conditions ecchymoses may occur. Pigmentation may fol- 

 low large or small interstitial haemorrhages. 



As a result of embolism or thrombosis of the inesenteric vessels haemor- 

 rhagic infarctions may occur, sometimes involving considerable portion 

 of the gut. 2 Haemorrhage into the lumen may follow, or gangrene, or 

 inflammation. The latter processes are readily induced in the injured 

 regions by the bacteria constantly present in the intestinal contents. 

 Septic emboli may induce suppurative inflammation in the mesentery and 

 in the wall of the intestine. 



Intestinal haemorrhage may occur in venous congestion, as in certain 

 forms of cirrhosis of the liver. It may follow ulceration, in typhoid 

 fever, in chronic colitis, in malignant tumors, etc. ; it may accompany 

 infarction. 



DEGENERATION. 



Amyloid Degeneration may be associated with a similar process else- 

 where in the body. The iodin test may reveal the existence of this 

 alteration in the villi of the small intestine. 



INFLAMMATION. 



INFLAMMATION OF THE SMALL INTESTINE. (Enteritis.) 



Acute Catarrhal Enteritis. This may occur under conditions similar 

 to those inciting catarrhal inflammation in the stomach. It may be local 

 or general and may be associated with similar processes in the stomach 

 and colon. In ptomam poisoning the lesions are often severe. Coni- 



1 See summary of cases by Oallaverdin, Gaz. des Hopitaux, Aug. 24th and 31st, 1901, 

 bibliography. 



2 For a fuller consideration of thrombosis of the mesenteric veins consult Welch, All- 

 butt's "System of Medicine," vol. vi., p. 218. 



