424 Iiitcnial Strangulation of the Intestine. 



can accomplish something; the object of the operation is to 

 relieve the strangulated intestine; this may be accomplished 

 from the rectum in some cases, in horses as well as in cattle. 

 However, a laparotomy cannot be avoided in the majority of 

 cases in the horse and frequently also in cattle, and this oper- 

 ation is the only one possible in smaller animals. 



One cannot lay down a uniform law for the reduction per 

 rectum, since local conditions vary not only as to different, but 

 even as to the same types of intestinal internal strangulation. 

 However, the more frequently rectal exploration is practiced 

 in the examination of patients, the more frequently are found 

 cases in which it is possible to liberate from the rectum loops 

 of intestines that are strangulated by bands or pediculated tu- 

 mor, either l)y untwisting a band or by tearing it or the slender 

 pedicle of the tumor. Perl succeeded in tearing with his spread 

 fingers the pedicle of a lipoma, the pedicle having strangulated 

 the rectum (the authors attempted the same procedure in two 

 cases of strangulation l)y pediculated lipomata, but they were 

 not successful). 



Strangulation of the intestines by the nephro-splenic ligament may be over- 

 come in horses in the following manner: The right hand is introrjuced into the 

 rectum of the standing animal, and it is then pushed between the stretched nephro- 

 splenic ligament and the comjiressed Ijowel ; the latter is then grasped to the right 

 and below and is pushed towards the left, being at the same time pressed down 

 with the thumb. While executing this rotating motion towards the left, the back 

 of the hand attempts to displace the base of the spleen towards the median line of 

 the abdominal cavity. The intestines can usually be released within fifteen or 

 thirty minutes, occasionally within a few minutes. In four of the authors' five cases, 

 they succeeded without trouble, but in one case a laparotomy became necessary Tors- 

 sell has relieved cases of this type by this method ; he placed the patients on the back. 



In spermatic duct strangulation of oxen one may, if the condition has not 

 lasted long, attempt to press the intestines which are not yet bloated through the 

 strangulating ring. As a rule, however, the animals are only seen after they have been 

 sick some time, then the spermatic cord must be separated or torn loose. After 

 the posterior portion of the abdomen of the patient has been elevated, the well- 

 greased arm is introduceil into the rectum up to the elbow, then one attempts either 

 to separate the duct or to tear it loose. The o]>orative jirocedure is variously de- 

 scribed by different authors. Walch grasps the cord between thumb and index 

 finger, then closes the hand and turns it downward and to the right, and also drawa 

 it backwards and to the left. 



Servatius grasps the cord from above, from right to left and winds it once 

 around the index finger in a spiral ; he then closes this finger and presses it against 

 the thumb. Then he pulls towards the abdomen and tears the cord away from its 

 attachment. Tn animals more than two years old, when the attachjuent of the 

 spermatic cord is much firmer, he attempts to grasp it with the whole hand, brings 

 it to the back of the hand, winds it around the wrist and now tries to tear it loose 

 with one strong pull; if possible an assistant pulls at the same time on the scrotum. 



Hoffmann draws the cord with the tip of the fingers or with the whole fist 

 from in front ui)wards and then from within l)ackwar<ls into the middle of the 

 pelvis; the cord is usually torn during this manipulation. If, however, a tear does 

 not occur, he winds the elastic cord from one to three times around his hand and 

 changes the direction of the traction backwards, upwards and to the left. 



The described procedures usually succeed in relieving internal strangulation 

 in oxen. (Probst succeeded in twenty-seven case out of twenty-nine.) 



Such procedures as driving uphill, elevating by pulling high the hind portion 

 of the animal, rolling on the back, are absolutely unpromisiusr in interiial spermatic 

 duct strangulation. The proprietors of animals must be taught to avoid methods of 

 castrating male calves which are liable to bring about this affection. 



