418 



Internal Strangulation of the Intestine. 



9 



other cases they soon become less frequent and are eventually 

 suppressed. 



Defecation ceases at once or soon; in exceptional cases, 

 when the strangulation is not complete, there may be only re- 

 tarded defecation in the further course of the disease. 



Eectal examination shows that the rectum is empty and 

 frequently the strangulation of some parts of the intestines, 

 its seat and its origin, can be ascertained. In strangulation of 

 the rectum the hand meets an impediment and it is frequently 

 impossible to pass even one finger. The wall of the intestine 

 is folded in front of the obstruction and is tender; if it is pos- 

 sible to press the finger through the impediment this is found 

 coated with a dirty, reddish, fetid fluid. In strangulation of any 

 other portion of the intestines one can ascertain that there is 



somewhere a much 



bloated intestinal 

 portion which de- 

 creases in one place 

 to a folded string; 

 here the tissues are 

 tender and surround- 

 ed by a tense ring. 

 Sometimes one finds 

 pediculated tumor- 

 like formations, and 

 occasionally it is 

 even possible to de- 

 termine the direction 

 in which the con- 

 stricting band or the 

 ])ediculated body has 

 l^ecome wound around 

 the bowel. If tlie 

 place f strangula- 

 tion is in the anterior 

 portion of the abdo- 

 men, which cannot be 

 reached by the hand, 

 it is possible at most to demonstrate circumscribed bloating and 

 tenderness of certain portions of the intestines, or the examina- 

 tion may at first be perfectl}^ negative while later on a gradually 

 increasing bloating of moderate degree will be noticed of the 

 parts situated in front of the strangulation towards the stomach. 



Fig. 45. Loop of small intestine (a, h) . strangulated 

 in a cleft of the mesentery ( r ) . 



In strangulation of the intestines 1\y the ne]ihro-f-]ilenic ligament, one can 

 tain that the spleen is not in contact with the left abdominal wall as usual, and its 

 base has been displaced far downward, approximately to the middle of the left 

 abdominal wall, while the ligament has been drawn out to a cord 15-20 em. long. 

 In the ring which is not closed entirely and is formed by the nephro-splenic ligament, 

 the free upper end of the base of the spleen, which is usually horizontal, by the left 

 kidney and the left abdominal wall, one finds the left portion of the colon suspended 



