386 Internal Closure of the Intestine, 



cuius is situated more anteriorly one might try to push it into 

 the stomach-like dilatation (Colin) ; this attempt is, however, 

 rarely successful on account of the accumulation of feces in 

 front of the place of obturation, as the authors' observations 

 in this respect have shown. One may also try the injection of 

 large amounts of water (30-40 liters at one time). 



Topper recommends Masch's meconotoriiim for the removal of 

 meconium which is impacted in the rectum ; this instrument has the 

 shape of a spoon and it must he introduced repeatedly with care. After 

 cleaning out the rectum an injection is given (1 quart of 1% Lysol 

 solution) and internally 1.0 calomel with 50 gm. castor oil. 



If these attempts fail or if the size and shape of the obturat- 

 ing body exclude the possibility of success from the start, laxa- 

 tives should not be given, but a laparo-enterotomy might be 

 tried. However, the latter will be successful only in verj^ ex- 

 ceptional cases, since the union of the stomachlike dilatation of 

 the large colon into the small colon is usually displaced into the 

 latter, and it therefore becomes impossible to draw this portion 

 of the intestine into the wound of the abdominal wall, because 

 the former is too firmly connected wdtli the upper al)dominal 

 wall. The operative procedure appears indicated only in obtu- 

 ration of the small colon with its long mesentery or in obturation 

 of the pelvic flexure. The left side should be selected for the 

 abdominal incision. The right would be preferable in ol)tura- 

 tion of the head of the cecum, but this condition cannot be diag- 

 nosticated intra vitam. Hoffmann recommends the removal of 

 the calculi wedged in the posterior portion of the rectum, by 

 introducing the hand through the laparotomy wound and push- 

 ing carefully the stone towards the rectum where it will be 

 grasped and extracted by the hand of an assistant (water should 

 be introduced beforehand if the stone is of any considerable 

 size). Large calculi can, of course, not be removed by this 

 route. 



If a large calculus is situated iu the stomaeli-like dilatation so that it occludes 

 the opening of the small colon, it is impossible to pull this part into the laparotomy 

 wounil as it is provided with a short meseutery only. I'rovided there is not yet any 

 considerable fecal impaction one may, however, try to draw the right upper portion 

 of the colon into the wound made immediately below the right costal arch, to incise 

 this portion of the bowel, introduce the liand into it and push it forward until the 

 stone can be grasped and extracted. An attempt of this kind was, however, futile 

 in a case of Plosz «& Marek because the upper right portion of the colon was so much 

 filled with firm fecal masses that it could not be drawn into the laparotomy wound. 



One can, anyhow, expect success from laparo-enterotomy only if dry feces have 

 accumulated in larger amount in front of the obturating body and in the absence of 

 grave complications, such as enteritis, peritonitis, intestinal rupture. A case of 

 Felizet in which a calculus, the size of a child 's head, was successfully removed by 

 an operation made at the proper time proves that it may be carried out to bring re- 

 lief and recovery. In the cases reported by Eichard, Dollar & Eogers, by Hall, Boeder 

 and Lowe, and in three cases of Marek & Plosz the patients operated upon all died. 



Obturating foreign bodies in cattle may also be removed by 

 operative procedure, as is shown by the observations of Sporer 

 and Feser. 



