422 Internal Slrangulatiun of the Intestine. 



Diagnosis. Internal strangulation of the intestine can be 

 diagnosticated with certainty only if rectal examination or pal- 

 pation of the abdomen furnish a positive result ; all other symp- 

 toms can at best furnish a more or less well founded suspicion. 

 If there is good ground for a strong suspicion an exploratory 

 laparotomy should be made in cattle and in dogs, occasionally 

 also in other animals; this enables us to determine, b}^ the aid 

 of the hand which is introduced through the laparotomy incis- 

 ion, the seat and origin of an existing strangulation. In steers 

 less than 9 to 10 months old, where a rectal examination cannot 

 be made, an exploratory laparotomy should be made in all cases 

 when sudden symptoms of colic have come on with constipation, 

 and where treatment during a period of twelve hours has not 

 brought about any improvement (Hoffmann). If there are 

 symptoms pointing to ol)struction of the intestines and one 

 hears over the posterior, lower parts of one side of the thorax 

 tympanitic or possibly metallic percussion sounds which are 

 variable in pitcli and intensity, if quite intense intestinal sounds 

 are audible in this region, and if symptoms of beginning pleu- 

 ritis or hemothorax appear soon, then a diagnosis of incar- 

 cerated diaphragmatic hernia appears safe, especially after an 

 exploratory puncture of the thorax has furnished hemorrhagic 

 intestinal contents. Aside from strangulation, circumscribed 

 intestinal meteorism is encountered also in torsion of 

 the intestine, in the grave form of thrombosis, in acute 

 dilatation of the stomach, hence this can only be utilized 

 as a suggestive symptom in connection with other symp- 

 toms, and with certain circumstantial evidence in those cases 

 where the exact site of the incarceration cannot be felt or other- 

 wise ascertained directly. However, if dealing with a strong 

 meteorism localized to a few loops of intestines, one is seldom 

 in error in thinking of intestinal strangulation, torsion or vol- 

 vulus. The clear, yellowish or slightly reddish serous fluid, 

 which is at first ol)tained by exploratory puncture of the ab- 

 dominal cavity, is found in internal strangulation, torsion, in- 

 vagination, and in the graver forms of thrombosis of the mesen- 

 teric arteries. 



The differential diagnosis has to consider in particular 

 acute dilatation of the stomach, the grave forms of thrombosis, 

 torsion, volvulus and invagination of the intestine, incarcerated 

 genuine hernia, internal olistruction of the bowel and in cattle 

 also obstruction of the urethra by calculi. 



Acute primary dilatation of the stomach of the horse can 

 be excluded with certainty, in the majority of cases, by anam- 

 nestic data, such as early difficulty in respiration, al)sence of 

 early and marked disturbances of defecation and rapid improve- 

 ment, and definite recovery after the proper use of the stomach 

 tube. Torsion, volvulus and invagination can only be differenti- 

 ated from internal strangulation by the findings on rectal exami- 

 nation. It is not of very great importance if it is impossible 



