Anatomical Changes. 403 



with their symptoms follow; some of the symptoms seen in 

 oertain cases may also he due to hloating of larger portions 

 of intestines. 



AVhat has heen said in the preceding pages explains why 

 thrombosis of mesenteric arteries, though common in conse- 

 quence of the factors which cause it (sclerostoma), comparative- 

 ly rarely lead to recognizable functional disturbances. The 

 statement of Bollinger that three-fourths of all cases of colic 

 are due to aneurysma of the mesenteric arteries is beyond doubt 

 exaggerated. A thrombotic-embolic affection as the cause of 

 colic is only diagnosticated in about 15% of the cases of colic 

 seen in the Budapest CUnic (see also page 393). 



Anatomical Changes. Aside from complications like en- 

 teritis or intestinal displacements those cases terminate fatally 

 in which the circulatory disturbances are not compensated. In 

 a certain portion of the intestines, generally in the colon, more 

 rarely in the cecum, or in both simultaneously, or in the small in- 

 testines and exceptionally in the small colon, we find on post- 

 mortem examination the mucosa and frequently also the serosa 

 dark blackish red, the mucosa forms pendulous projections, the 

 submucous tissue and the neighboring mesentery are more or 

 less infiltrated wdth a reddish-yellow serum and considerably 

 thickened (1-3 cm). Similar infiltrations are seen on the ex- 

 terior layers of the bowel-wall. The affected portion is, as a 

 rule, sharply defined, both from the oral and from the caudal 

 healthy portions, and the boundaries usually correspond to the 

 territories supplied by arterial branches situated above the 

 thrombosed point (see page 397). The intestinal contents in 

 the affected portion and in different cases at a variable distance 

 towards the anus appear dark tarry, bloody, sometimes only 

 reddish and occasionally of normal color, but always thinner. 

 The surface of the mucosa is covered by branlike dead shreds 

 of epithelia, sometimes also with masses of fibrin. In grave 

 cases the necrosis may have spread into the serosa and then yel- 

 lowish spots can be seen from the outside. Exceptionally only 

 do some portions of the intestine shoAV a yellowish or greenish 

 discoloration in consequence of anemic necrosis (in a case of 

 Casper a part of the rectum, and the small colon, were necrotic). 

 Yellowish or reddish-yellow serous fluid, often also a fibrinous 

 exudate is found in the peritoneal cavity. The evidences of 

 rupture of the intestines or stomach may also be present. 



Then there are found thrombi or emboli in the trunk of the 

 mesenteric artery or rather in the art. ileo-coecolica, more rarely 

 in one of the arteries of the colon or in the arteriae jejunales, 

 rarely in the posterior mesenteric artery; emboli are usually 

 found in the smaller branches. The blood coagula are some- 

 times fresh in appearance, rather moist and elastic, at other 

 times drier and firmer, strongly adherent to the intima ; some- 

 times a number of thrombi are found in the same vessels follow- 



