436 Volvulus and Torsion of the Intestine. 



1. If the left upper division lies to the right of the lower division 

 and if it passes here o})liquely forward, upward and to the left, then 

 we are dealing with a half twist towards the right. If the left npper 

 division passes ol)li(iuely forward and downward and to the left, then we 

 have a twist to the left of more than 90°. 



2. If one feels the left upper division to the left of the lower 

 division and if it leads ol)li(iuely forward and downward and to the 

 right, then we are dealing with torsion to the right of more than 90° ; if 

 it leads obli(iuely forward and upward and to the right, then we are 

 dealing with a half torsion to the left. 



3. In those rare eases where the left lower division completely 

 covers the upper division, the spiral course of the band and indentations 

 of the left lower division which may he present are the deciding factors. 



Concerning the details of diagnosis, including differential 

 diagnosis, the reader is referred to the subject of internal stran- 

 gulation (see page 422). Even where rectal examination or 

 external abdominal palpation give information, the affection 

 cannot always be diif erentiated from internal strangulation, but 

 this is of no great importance, since the therapeutic procedures 

 are the same in both cases. 



Treatment. The same principles as those laid down for the 

 treatment of internal strangulation (see page 423) govern on 

 the whole the treatment of torsion or volvulus. However, the 

 very nature of these affections brings it about that, except in a 

 case of torsion of the colon, reposition from the rectum is even 

 less frequently possible than in internal strangulation. 



In torsion of the colon one should always roll the horses in 

 the direction of the torsion whether it be diagnosticated posi- 

 tively or only suspected. Forssell has recently had some good 

 results with this procedure. 



Relief of torsion of the colon by rolling, according to Forssell, is hronglit 

 about as follows: According to the Stuttgart method the horse is best placed on 

 the side corresponding to the twist of torsion, that is, if torsion is towards the right, 

 the horse is placed on the right side. Before this is done the bloated colon must 

 have been punctured either through the left abdominal wall or through the rectum 

 (see page 363). Then the arm of the operator is introduced into tlie rectum; he 

 next tries to fix the pelvic flexure with his fingers (in mares one may make an 

 incision into the vagina for this pur])0se) ; indeed, according to Forssell, the intestine 

 becomes fixed Ijy its own weight. Then the horse is rolled on its back and abdomen 

 till the intestine gets into its proper position. (A horse had to be rolled nine times 

 in a case of Forssell before replacement occurred.) To prevent rupture of the 

 rectum, the fixation with the fingers must be interrupted from time to time. The 

 reposition of the bowel is usually announced by the expulsion of intestinal gases, 

 although sometimes flatus does not immediately occur. The restlessness persists for 

 a, few hours if the rolling was performed a few hours after the onset of the dis- 

 ease; if, however, the horses have been sick for fifteen or twenty hours, they become 

 quiet almost immediately after reposition. The after treatment consists in starva- 

 tion or in very careful feeding for several days. 



The therapeutic value of rolling in torsion of the colon cannot be judged 

 accurately on account of the uncertainty of the clinical diagnosis and the compara- 

 tively small nund)er of observations in this respect. Forssell reports seventeen 

 recoveries in eighteen cases so treated. Other authors (Behrens, Hummerich) have, 

 however, not been able to get such brilliant results. Hummerich and Kalcher, on 

 the other hand (see pages 363 and 372) have been successful in treating many 



