Treatment. 437 



cases of primary intestinal nieteorism and impaction by rolling which indeed is 

 nothing more or less than a particularly energetic abdominal massage; these diseases 

 may, as pointed out, easily be confounded with torsion of the colon on account of 

 the" frequent change in the inter-relations of the left divisions of the colon. It 

 appears at least questionable, therefore, whether indeed the majority of cases of 

 torsion of the colon can be cured by rolling. If the place of torsion is in the 

 transverse colon or more towards the periphery in the left divisions, then reposition 

 by rolling may easily succeed ; in torsions of the right division, which appear to 

 be more common, rolling cannot have any immediate effect, because the place of 

 torsion does not coincide with the place around which the colon turns in rolling. 

 Only very accidentally might the normal position be then restored. (In one of the 

 authors' cases with a torsion of all divisions of the colon to the left, repeated rolling 

 after twice puncturing the bowel remained without any effect at all.) 



In consideration of experiences with the correction of torsion of the uterus, it 

 appears rather strange that rolling of horses with a supposed torsion of the colon, 

 in the wrong direction, should not lie at all detrimental ; that it should not be capable 

 of producing torsion of the colon in horses with other intestinal affections, and that 

 it should favorably influence bloating of the cecum, which is claimed to be caused 

 always (?) by torsion of the cecum around its long axis. 



The correction through the rectum of torsion of the colon, according to 

 Jelkmann and Moller, is performed on the standing animal after a preliminary 

 puncture of the intestine. The posterior abdominal portion of the animal is first 

 elevated, the hand is then introduced into the rectum, and guided towards the left 

 abdominal wall. The hand then tries to push forward and inward the accessible 

 loops of the sjnall colon and those divisions of the colon which are above the former; 

 if the median line has never lieen reached the hand is guided upward, whereupon, in 

 favorable cases, the colon glides into the place of the loops of the small colon which 

 have been pushed aside ; in this manner the torsion may become relieved. 



This procedure was recommended by Jelkmann and is indicated only in tor- 

 sion towards the left. Moller proceeds in another manner. He pushes with the 

 hand, introduced into the rectum, the upper division, which is twisted towards the 

 left, upward and at the same time the lower division downward and to the left. 



The experiences of Larsen, Keutzer, Forssell, Straube, however, and the obser- 

 vation of the authors show that, even with a good deal of force and persistency, tor- 

 sion cannot be corrected because the colon is such a heavy body that it cannot 

 easily be moved in the closed abdominal cavity where neighboring loops of intes- 

 tines at once occupy every space that might be made free. Forssell also calls atten- 

 tion to the ever present danger of rupture of the rectum. Jelkmann, Moller, Malk- 

 mus, Zippel and others have had good results in those cases which belonged to the 

 type of cases recommended for their procedures by Jelkmann and Moller. 



Kinking of the pelvic flexure can be corrected from the rectum by pulling to- 

 wards the pelvis (Diem). Sigl has relieved a ease of torsion of the small colon by 

 the injection of water into the section situated in front of the impediment. 



When a reliable diagnosis lias been made laparotomy is 

 usually the only indicated procedure except in cases of torsion 

 and kinking of the large intestine. Aside from its danger to 

 life, however, even this procedure cannot always produce the 

 desired result, as is evident from the nature of the disease itself. 

 The experiences of the authors show that volvulus or extensive 

 torsion of the mesentery cannot be cured even by this operative 

 procedure. In torsion of the colon, laparotomy with subsequent 

 rolling may be indicated (Forssell). Concerning the indica- 

 tions for laparotomy the reader is referred to the subject of in- 

 testinal strangulation (see page 425). 



In a case in a horse where loops of the small intestines had become twisted 

 around the small colon Meschkow was able to replace the displaced loops after open- 

 ing up the right flank; recovery took place. Sigl had a similarly good result in 

 volvulus of the small colon. Audeliert replaced divisions of the colon, alleged to 

 have been displaced, with the hand introduced through an incision into the wall of 

 the vagina. JPlosz & Marek were unable in two cases to reduce a mesenteric torsion 

 of almost all of the small intestine after laparotomy. Eies performed laparotomy 



