416 Internal Strauuulation of tlie Intestine. 



Throwing down or rolling with snddenly increasing abdominal 

 pressure may, on the other hand, force more loops of intestines 

 through the place of strangulation by pressure from behind 

 (Kertesz). 



The strangulated portion of bowel, which is filled with in- 

 testinal contents mixed with extravasated blood, will soon be- 

 come bloated, because the gases can neither be removed towards 

 the stomach nor towards the anus, nor can they be absorbed by 

 the blood. Peristalsis and pain finally cease in the strangulated 

 portion after it has been dilated ad maximum and after edem- 

 atous infiltration has occurred. Peristalsis of the portions 

 situated between the strangulation and the anus cease almost 

 at once or shortly after the strangulation occurred. Contrac- 

 tions persist for a long time in the portions situated anteriorly 

 to the point of strangulation, and some may later become con- 

 vulsive and cause pain; the latter is, however, not very severe, 

 as shown by the experiments of the authors. Peristalsis in the 

 last mentioned portion of the bowel decreases as the intestinal 

 contents undergo a more and more active fermentation, and 

 finally they likewise cease. 



The gradually increasing swelling of the intestinal wall and 

 of the mesentery, and the involvement of more loops of intes- 

 tines produce increased pressure upon the sensory nerves that 

 are caught in the place of strangulation ; this causes a continu- 

 ous, but not severe pain, as experiments on horses show ; the lat- 

 ter may even be entirely absent where the strangulation is not 

 too severe. In the further course continuous pain, which increases 

 on pressure, is also caused by peritonitis which develops. The 

 general symptoms are similar in origin and character to those 

 encountered in thrombosis of the mesenteric arteries (see page 

 403) ; however, they vary in different species of animals as to 

 their appearance, according to variability in susceptibility to 

 microorganisms and their toxins. The shorter the strangulated 

 portion of intestine and the less firm the strangulation, the later 

 and the less severely will these general symptoms appear. 



Anatomical Changes. The strangulated portion of intes- 

 tine appears, as a rule, dark to blackish red, distended and 

 tense, the wall thickened by serous-hemorrhagic infiltration, 

 friable, the intestinal lumen filled with a thin fluid, fetid, hemor- 

 rhagic mass, the mucosa blackish red, on the surface dirty yel- 

 lowish, smeary. The site of the strangulation is indicated l)y a 

 pale yellowdsh strip ; sometimes the strangulated portion shows 

 several segments, separated from each other by pale rings with 

 alternating reddened portions (gradual entrance of the strangu- 

 lated portion in sections). Aside from strangulation a circum- 

 scribed or diffuse peritonitis, and perhaps intestinal rupture 

 may be found. The peritoneal cavity contains a yellowish or 

 reddish serous exudate, frequently mixed with shreds of fibrin. 



