596 GASTRO-INTESTINAL "AUTOINTOXICATION" 



Acute Intestinal Obstruction 



The violent effects that follow complete occlusion of the intes- 

 tine, especially in the upper portion, must be due to some highly toxic 

 substance or substances. The clinical features of obstructive ileus, 

 namely, vomiting, collapse, complete muscular relaxation, and sub- 

 normal temperature, are associated with the excretion of large quan- 

 tities of indican and other substances combined with sulphuric acid, 

 proving that intestinal putrefaction is active. Undoubtedly in ileus 

 we have a profound and rapidly fatal intoxication with substances 

 formed in the obstructed intestines. 



Whipple^^ has demonstrated that closed duodenal loops in dogs 

 come to contain a highly toxic substance of unknown nature, appar- 

 ently formed in the epithelium of the gut rather than in its contents, 

 which causes severe splanchnic congestion, vomiting and diarrhoea 

 when injected into normal dogs. The toxic agent is not destroyed by 

 autolysis, filtration or heating at 60°, yet dogs can be made somewhat 

 refractory or immune. From the contents of such loops, and from the 

 bowel above obstructions, he has isolated a very toxic proteose,-" which 

 he believes may be responsible for the intoxication. Whether this 

 proteose, or whatever the active poison may be, comes from bacterial 

 infection, autolysis, duodenal secretion, or what, is not yet agreed by 

 the numerous investigators in this field. -^ There is much evidence in 

 favor of the essential importance of bacteria, and it is held by some 

 that toxic amines may be produced by bacterial action in the closed 

 loops, ^" and that injury to the mucosa facilitates absorption of the 

 poisons. Apparently the liver does not have much detoxicating effect, 

 for dogs with Eck fistula behave much the same when the intestine is 

 obstructed as dogs with normal circulation. A similar material can- 

 not be obtained by hydrolysis or autolysis of normal duodenal mucosa, 

 the obstruction being an essential feature. The normal intestinal 

 secretions do not have any considerable toxicit3^-^ Obstruction of 

 lower portions of the intestine has much less effect'^ and it has been 

 suggested that the poison formed in the duodenum is neutralized or 

 destroyed farther down in the intestine.-^ A striking feature of 

 intestinal obstruction is the high non-protein nitrogen content of the 

 blood, figures similar to those of fatal uremic coma being common,-^ 

 which may be the result of absorption of cleavage products from the 

 intestine, or toxicogenic destruction of tissue proteins, or both. There 

 is also pro1)ably an element of renal injury and reduced excretion.-^ 



'» Whipple, Stone and Bernheim, Jour. Exp. Mod., 1913 (17), 280. 

 -"Jour. Aiuer. Med. Assoc, 1915 (G5), 470; 1910 (07), 15; Jour. Exp. Med., 

 1910 (23), 123; 1917 (25), 231 and 401. 



2^ Review hv South and Hardt, Arcli. Int. Med., 191S (21), 292. 



■^~ Drajistedt et nl., Jour. Exp. Med., 1919 (30), 109. 



" Davis and Stone, Jour. Exp. Med., 1917 (20), OSO. 



■■"See BuiitiiifT, Jour. ]<;xi). Med., 1913 (17), 192. 



" Maurv, Ainer. Jour. Med. Sei., 1909 (137), 725. 



" Cooke, Hodenhaumh and Whipple, Jour. Exp. Med., 1910 (23), 123. 



"McQuarric and W liipple. Jour. Exp. Med., 1919 (29), 397. 



